Purpose: To evaluate the long-term efficacy and safety of trabeculectomy with or without low dosage Mitomycin-C (MMC) in primary open angle glaucoma (POAG).
Methods: 114 patients affected by POAG, participating in a randomized clinical trial from 1995 to 1998, were re-examined and their chart reviewed. Patients had undergone in one eye a trabeculectomy with intraoperative application (2 min) of MMC (0.2 mg/ml) or balanced saline solution (BSS), and, if indicated, post-operative laser suture lysis, bleb needling and/or digital massage. Intraocular pressure (IOP), medical therapy, visual field, further glaucoma surgery, cataract surgery, complication rate (leakage, cataract progression, hypotony, blebitis, endophthalmitis) were evaluated.
Results: 67 eyes had received MMC and 47 BSS. MMC-treated eyes had lower mean IOP (13.33+3.35 vs. 14.72+2.19 mmHg, P=0.014); in this group, an higher percentage of eyes had IOP¡Ü18 mmHg (73.1% vs. 51.1%, P=0.027) and IOP¡Ü14 mmHg (56.7% vs. 31.9%, P=0.015); a lower rate had further glaucoma surgery (9% vs. 25.5%, P=0.040), and visual field damage progression (21.1% vs. 48.6%, P=0.009). No difference was seen in the complication rate: one MMC-treated eye developed blebitis.
Conclusions: In POAG low-dose MMC with intensified post-operative management improved the outcome of the trabeculectomy with a low incidence of complications.