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K. Lim, S. Wickremasinghe, S. Lightman, C. Pavesio, C. Bunce, K. Barton; Trabeculectomy with Mitomycin–C in Uveitic Glaucoma . Invest. Ophthalmol. Vis. Sci. 2004;45(13):1055.
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Purpose: To evaluate the efficacy of intraoperative Mitomycin C (MMC) trabeculectomy in patients with glaucoma secondary to different uveitic entities, and to examine the importance of prior pseudophakia and subsequent cataract surgery in postoperative intraocular pressure (IOP) control. Methods: First eyes of consecutive patients with uveitic glaucoma attending a single sub–specialist clinic for uveitic glaucoma who underwent trabeculectomy with MMC after failure of medical therapy were enrolled in a prospective, noncomparative interventional case study between February 1998 and the present day. Aphakes, second eyes and repeat trabeculectomies were excluded. Visual acuity (VA), number of glaucoma medications, IOP, cup–disc ratio (CD), complications and other interventions were recorded. Qualified and complete successes were defined as IOP < 22 mmHg with or without glaucoma medications respectively.Results: 104 eyes were recruited and followed up for 22 ± 2 months [mean ± SEM]. Preoperative VA, IOP, glaucoma medications and CD were 6/12 (6/5 – HM) (median [range]), 30 ± 1mmHg (mean ± SEM), 3.4 ± 0.1 and 0.68 ± 0.02 respectively. At last follow–up VA was 6/12 (6/5 – NPL) . IOP, glaucoma medications and CD were 15 ± 1 mmHg, 0.4 ± 0.1 medications and 0.67 ± 0.02 respectively. The overall success rates were 72% (complete) and 94% (qualified). The lowest cumulative complete success rate for any uveitis type was 30% for Fuchs’ heterochromic cyclitis, compared with 75%, 78%, 64% and 85% for acute anterior, chronic anterior, intermediate, and panuveitis respectively. Complete (and qualified) success rates were 62% (86%), 72% (95%) and 81% (100%) for pseudophakia before trabeculectomy, phacoemulsification after trabeculectomy, and eyes that remained phakic throughout, respectively. These factors were examined by multivariate analysis which demonstrated a significant association between trabeculectomy failure and pseudophakia before trabeculectomy (p = 0.016). No assocation was demonstrated with the other risk factors examined. Conclusions: MMC trabeculectomy appears to be a successful method of controlling the IOP in uveitic glaucoma. Prior pseudophakia was significantly associated with a higher risk of trabeculectomy failure. Though eyes with Fuchs’heterochromic cyclitis appeared to fail most commonly, this seems to be related to a high frequency of preoperative pseudophakia (8/10) in this group. These results suggest that alternative surgical strategies should be considered in pseudophakic eyes with uveitic glaucoma.
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