Elsevier

Ophthalmology

Volume 105, Issue 4, 1 April 1998, Pages 740-745
Ophthalmology

The role of adjunctive mitomycin C in secondary glaucoma triple procedure as compared to primary glaucoma triple procedure☆

Presented in part as a poster at the American Academy of Ophthalmology Annual Meeting, Chicago, Illinois, October, 1996.
https://doi.org/10.1016/S0161-6420(98)94032-5Get rights and content

Abstract

Objective

This study aimed to investigate whether previously failed glaucoma filtration surgery is a risk factor for filtration failure of subsequent trabeculectomy combined with cataract surgery and to determine the role of adjunctive mitomycin C (MMC) in the secondary glaucoma triple procedure (SGTP) as compared to primary glaucoma triple procedure (PGTP).

Design

A prospective, controlled study that was randomized with respect to assignment to adjunctive MMC and a case-control design with respect to comparisons between SGTP and PGTP was studied.

Participants

The SGTP group consisted of 49 eyes of 49 consecutive patients with primary open-angle glaucoma with a history of glaucoma filtration surgery requiring glaucoma medical therapy and in need of cataract surgery, randomized to adjunctive MMC (SGTP MMC subgroup of 21 eyes) and no adjunctive MMC (SGTP control subgroup of 28 eyes). The PGTP group consisted of 49 PGTP cases closely matched to the SGTP cases with respect to age, race, gender, MMC use, C:D ratio, and systemic diseases.

Intervention

Trabeculectomy combined with phacoemulsification and a small incision (5 × 6 mm), all polymethylmethacrylate posterior chamber intraocular lens implantation with or without adjunctive MMC (0.5 mg/ml for 1 minute), was performed.

Main outcome measures

Surgery failure was defined as the need of an additional intraocular procedure or the need of more than one medication to achieve intraocular pressure control to the target level. Intragroup and intergroup comparisons were made with respect to filtration outcome among the SGTP and PGTP patients.

Results

Without adjunctive MMC, filtration success was significantly less in SGTP than in PGTP (P = 0.03). Adjunctive MMC significantly increased the success rate of SGTP (P = 0.02) but not that of PGTP (P = 0.89) over the average follow-up period of 2 years.

Conclusions

Previously failed glaucoma filtration surgery is a significant risk factor for the filtration failure of combined surgery. Intraoperative use of adjunctive MMC significantly improves the filtration success rate of SGTP.

Section snippets

Patients and methods

This study represents an intermediate-term evaluation of an ongoing prospective study to investigate the role of adjunctive MMC in SGTP as compared to PGTP. Patients with primary open-angle glaucoma (POAG), with a history of glaucoma filtration surgery, requiring glaucoma medical therapy, and in need of safeguarding against IOP spike-related optic nerve damage during the early postoperative period, long-term improvement of glaucoma control with respect to either IOP or medical dependency, and

Results

There were no significant differences between the MMC and control subgroups of both SGTP and PGTP groups in age, race, gender, systemic diseases, C:D ratio, preoperative IOP, and preoperative number of medications (Table 1). In addition, both the SGTP and PGTP groups and their respective MMC and control subgroups had the same race and gender distributions, respectively, according to the study design and also were similar in age, C:D ratio, and systemic diseases (Table 1). The SGTP group had

Discussion

Both SGTP and PGTP resulted in significant decreases in number of medications (Table 2). However, SGTP did not result in significantly decreased mean IOPs, whereas PGTP resulted in significant decreases of postoperative mean IOPs (Table 2). Furthermore, the success rate was significantly lower in the SGTP control subgroup than in the PGTP control subgroup (Fig 1). Conversely, with the use of adjunctive MMC, the success rate of SGTP increased significantly, such that it did not differ from that

References (37)

  • J.M. Liebmann et al.

    Initial 5-fluorouracil trabeculectomy in uncomplicated glaucoma

    Ophthalmology

    (1991)
  • T.H. Kupin et al.

    Adjunctive mitomycin C in primary trabeculectomy in phakic eyes

    Am J Ophthalmol

    (1995)
  • D.H. Shin et al.

    Primary glaucoma triple procedure with or without adjunctive mitomycin. Prognostic factors for filtration failure

    Ophthalmology

    (1996)
  • G.L. Skuta et al.

    Wound healing in glaucoma filtering surgery

    Surv Ophthalmol

    (1987)
  • D.H. Shin et al.

    Adjunctive subconjunctival mitomycin C in glaucoma triple procedure

    Ophthalmology

    (1995)
  • J.M. O’Grady et al.

    Trabeculectomy, phacoemulsification, and posterior chamber lens implantation with and without 5-fluorouracil

    Am J Ophthalmol

    (1993)
  • P.C. Wong et al.

    5-Fluorouracil after primary combined filtration surgery

    Am J Ophthalmol

    (1994)
  • K.M. Joos et al.

    One-year follow-up results of combined mitomycin C trabeculectomy and extracapsular cataract extraction

    Ophthalmology

    (1995)

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    ☆

    Supported in part by a grant from Research to Prevent Blindness, Inc., New York, New York.

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    Copyright © 1998 American Academy of Ophthalmology, Inc. Published by Elsevier Inc. All rights reserved.