ABSTRACT
Purpose: To evaluate the surgical outcomes of repeat trabeculectomy augmented with risk factor adjusted mitomycin C (MMC) exposure in eyes with previous failed trabeculectomy. Methods: Case records of 38 eyes of 37 patients with previous failed filter who underwent repeat trabeculectomy with MMC were reviewed retrospectively. Main outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP) reduction, requirement of anti-glaucoma medications, postoperative complications, and surgical success (defined as IOP of ?21 mmHg and >5 mmHg along with 20% reduction from preoperative IOP with or without adjuvant medications) at 1-year postoperatively. Statistical analysis was done using the STATA 14.1 (Texas, USA). Results: Patient's mean age was 46.41 (±20.43) years and the mean preoperative IOP was 32.73 (±9.26) mmHg which reduced to 16.22 (±7.08) mmHg postoperatively at 12 months (P < 0.001). Mean number of anti-glaucoma medications reduced from 2.76 (±0.83) preoperatively to 1.89 (±0.95) postoperatively (P < 0.001). Surgical success was observed in 81.1% at 1 year (n = 30). Eyes that received MMC >3 min had a postoperative mean IOP of 12.50 (±3.23) mmHg compared to 23.08 (±7.19) mmHg with MMC <3 min (P < 0.001). Seven eyes (18.4%) developed postoperative complications, and all were seen in eyes that received MMC >3 min (P = 0.033). Conclusion: Repeat trabeculectomy with MMC, used in higher concentration and exposure time altered according to individual risk factor plays a crucial role in the success and hence it could be considered as a viable option before planning a tube surgery.
ABSTRACT
PURPOSE: To compare the efficacy and safety of repeat and initial trabeculectomy with mitomycine C (MMC). METHODS: Eighty seven patients, who had underwent repeat (repeat group) or initial (initial group) trabeculectomy with MMC, were enrolled in this prospective trial. Postoperative outcome measures included the amount of decrease in intraocular pressure (IOP), the number of anti-glaucoma medications, and the complications. The success of trabeculectomy was defined on the basis of three definitions which were: IOP or =30% (definition 3). Success was further defined as "complete" when these criteria were obtained without any anti-glaucoma medications and "qualified" with or without medical therapy and no further surgical procedures. RESULTS: Fifty nine eyes underwent initial and 28 eyes underwent repeat trabeculectomy. The mean follow-up period was 19.1 +/- 5.9 months. Complete success rates were significantly greater in the initial trabeculectomy group (p = 0.02 for definition 1, p = 0.038 for definition 2, p = 0.003 for definition 3). A higher proportion of eyes in the initial group achieved qualified success relative to the group A eyes, but the differences were not statistically significant (p = 0.33 for definition 1, p = 0.99 for definition 2, p = 0.24 for definition 3). The mean number of antiglaucomatous medications at the last examination was 1.2 +/- 1.2 in repeat group and 0.7 +/- 1.1 in initial group (p = 0.01). The number of complications during the follow up period did not differ significantly between the two groups (p = 0.65). CONCLUSIONS: Repeat trabeculectomy with MMC has high success and low complication rates in patients with previously failed trabeculectomy in spite of the need of higher number of anti-glaucoma medications.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Alkylating Agents/administration & dosage , Combined Modality Therapy , Follow-Up Studies , Glaucoma/drug therapy , Intraocular Pressure/physiology , Mitomycin/administration & dosage , Prospective Studies , Reoperation , Trabeculectomy , Treatment OutcomeABSTRACT
PURPOSE: To evaluate the safety and efficacy of repeat trabeculectomy with mitomycin C (MMC) in the management of previous failed trabeculectomy patients. METHODS: We retrospectively reviewed the medical records of 44 eyes of 41 glaucoma patients who had been followed up for at least 6 months after repeat trabeculectomy with MMC and analyzed the success rates according to clinical factors, cumulative success rates, risk factors for surgical failure and complications. Surgical success was defined as an intraocular pressure (IOP) of 21 mmHg or less regardless of glaucoma medications and loss of vision. RESULTS: Postoperative success was obtained in 34 (77.3%) out of 44 eyes after a mean follow-up period of 38.7 months. From Kaplan-Meier survival analysis, cumulative success rates after 6, 12, 24, and 36 months were 97.7%, 89.6%, 83.5%, and 80.1%, respectively. Success rates were significantly lower in eyes with preoperative IOP of 30 mmHg or more. Postoperative complications included transient hypotony in 7 eyes, choroidal detachment in 4, hyphema in 4, and cataract progression in 4. CONCLUSIONS: The success rates of repeat trabeculectomy may be lower than of primary trabeculectomy. However, considering the relatively high success rates and low complications of repeat trabeculectomy with MMC compared to the reported results of glaucoma drainage device implantation, repeat trabeculectomy with MMC is an effective and relatively safe surgical option as the secondary surgical procedure for previously failed trabeculectomy patients.