Mitomycin helpful in severe glaucoma

MAASTRICHT, Netherlands — Adjunctive mitomycin-C may be warranted for trabeculectomy in patients with severe glaucoma, according to surgeons here.

Henny J.M. Beckers and colleagues at the University Eye Clinic reviewed the long-term efficacy and safety of primary trabeculectomy with mitomycin-C (MMC) in 60 eyes of 60 patients with severe glaucoma. The mean age of the patients was 72.5 years, and all patients underwent trabeculectomy between 1993 and 1995. Of the 60 patients, 42 had primary open-angle glaucoma, 10 had normal-pressure glaucoma, two had chronic narrow-angle glaucoma, five had pigment dispersion syndrome and one had pseudoexfoliation syndrome. MMC 0.2 mg/mL was applied under the scleral flap for 3 minutes.

Mean intraocular pressure (IOP) decreased from 22.3 mm Hg preoperatively to 12.6 mm Hg postoperatively. Success, defined as an IOP level of 15 mm Hg or less, was achieved in 83.3% of eyes at 1 year postop, dropping to 60% by year 6. Visual fields remained stable in 73% of eyes during the follow-up period. LogMAR visual acuity increased from 0.2 to 0.4.

Four eyes had undergone cataract surgery before their trabeculectomies; 13 eyes underwent cataract surgery during the follow-up period. Long-term complications were relatively mild, consisting of two cases of blebitis. Bleb reconstruction was performed in five eyes with overfiltration or bleb-related complaints.

The study is published in the February issue of Graefe’s Archive for Clinical and Experimental Ophthalmology.