[Hypotonous maculopathy following trabeculectomy with mitomycin C].

We retrospectively studied incidence, prognosis and predictive factors of hypotonous maculopathy following trabeculectomy with adjunctive mitomycin C. The subjects were 208 cases (208 eyes) with various types of glaucoma with clear media, who were followed up for at least three months postoperatively. The follow up periods ranged from 3 to 44 months with a mean of 21.1 months. The incidence of the maculopahy was 9.1% (19/208). The postoperative intraocular pressures (IOPs) varied between 1 and 6 mmHg in the presence of maculopathy. The maculopathy disappeared in 14 eyes (74%) spontaneously or following ocular hypertensive therapy including application of trichloracetic acid and subconjunctival injection of autologous blood. The final visual acuity deteriorated two lines or more in 8 eyes (42%). A discriminant analysis showed that age, history of intraocular surgery, preoperative maximum IOP, and mean deviation are the predictive factors for maculopathy. As compared with the hypotonous eyes without maculopathy, those with maculopathy tended to be younger and to have less severe visual field changes.

Trabeculectomy with mitomycin C for normal-tension glaucoma.

PURPOSE: A prospective investigation of the postoperative intraocular pressure level, visual function changes, and postoperative complications of trabeculectomy with adjunctive mitomycin C in normal-tension glaucoma. PATIENTS AND METHODS: Thirty-one patients (31 eyes) who underwent trabeculectomy with 0.4 mg/ml mitomycin C were studied. The preoperative intraocular pressure of the eyes ranged from 11 to 18 mm Hg with a mean (+/- SD) of 14.1 +/- 1.9 mm Hg. Follow-up examinations were performed at least once a month for 14-35 months (mean: 24.4 months). RESULTS: Intraocular pressures decreased to between 4 and 14 mm Hg with a mean (+/- SD) of 8.4 +/- 2.4 mm Hg at the last three follow-up visits. The magnitude of the intraocular pressure reduction ranged from 1 to 10 mm Hg, with a mean of 5.8 mm Hg. Final measurements of postoperative intraocular pressure ranged between 5 and 12 mm Hg in 27 eyes (87%). Visual acuity deteriorated two lines or more in seven eyes, which was caused by cataract. The visual field deteriorated postoperatively in two eyes (6%): their respective postoperative intraocular pressures averaged 9.4 and 7.5 mm Hg. Hypotonous maculopathy developed in three eyes (10%). CONCLUSIONS: Trabeculectomy with mitomycin C appears to have potential as a treatment modality of choice for normal-tension glaucoma, because a large majority of the patients in the present study achieved an intraocular pressure allegedly beneficial in managing normal-tension glaucoma.

[Trabeculectomy for normal-tension glaucoma].

We prospectively investigated the postoperative intraocular pressure (IOP) level, visual prognosis, and complications of trabeculectomy with adjunctive mitomycin C in normal-tension glaucoma. The subjects were 42 eyes of 29 patients who underwent surgery with 0.2 mg mitomycin C as an adjunct and were followed for 12-30 months (mean: 20.6 months). The preoperative IOP was 11-18 mmHg with a mean (+/- standard deviation) of 13.9 +/- 1.5 mmHg. The IOP decreased to 4-16 mmHg with a mean (+/- standard deviation) of 7.9 +/- 2.6 mmHg. The magnitude of the IOP reduction ranged from -1 to 10 mmHg with a mean of 6.0 mmHg. The number of eyes receiving ocular hypotensive medication decreased remarkably from 32 eyes preoperatively to 2 eyes postoperatively. The visual field deteriorated postoperatively in 2 eyes (4.8%) whose IOP was around 8 and 9 mmHg, respectively. Cataract progressed in 8 eyes (19.0%) and hypotonous maculopathy developed in 5 eyes (11.9%). Because the postoperative IOP level is close to the IOP value that is allegedly beneficial in preserving visual function in normal-tension glaucoma, the surgery is worth further consideration as a potent treatment for the disease.

Low-dose and high-dose mitomycin trabeculectomy as an initial surgery in primary open-angle glaucoma.

PURPOSE: The purpose of the study is to determine the optimum regimen of intraoperative administration of mitomycin as an adjunct to trabeculectomy. METHODS: Of 11 patients with primary open-angle glaucoma, 22 eyes that had not undergone any surgical intervention were included. In each patient, one eye was randomly allocated to a mitomycin 0.2-mg group and the fellow eye to a mitomycin 0.02-mg group. Mitomycin was applied for 5 minutes only once during trabeculectomy. The follow-up period was 6 to 17 months. RESULTS: Eleven (100%) eyes in the 0.2-mg group and 7 (63.6%) in the 0.02-mg group achieved successful control of intraocular pressure with or without topical antiglaucoma medication. Transient hypotony maculopathy (18%) and cataract progression (18%) were noted in the 0.2-mg group exclusively. The incidence of other complications was similar between the two groups. CONCLUSION: These data suggest that the most appropriate dose of mitomycin for primary surgery seems to be in between the two doses tested in the current study.