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Jose A Paczka, Miriam Adriana Ramos-Hdez, PM Madrigal-Ruiz, Luz A Giorgi-Sandoval, Elia P Chavez-Cedillo, Carmen L Soria-Orozco; Trabeculectomy supplemented with a high dose mitomycin-c for treating refractory pediatric glaucoma. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3162.
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To assess efficacy and safety of trabeculectomy supplemented with a high dose of mitomycin C (MMC) in children with refractory glaucoma.
In this retrospective non-comparative analysis, 31 consecutive cases affected by a mixture of pediatric glaucomas. Types of glaucomas included: congenital glaucoma after failed angle surgery (n = 17), aphakic / pseufophakic glaucoma (n = 4), Sturge-Weber syndrome (n = 3), traumatic glaucomas (n = 2), inflammatory glaucoma (n = 2), Axenfeld-Rieger syndrome (n = 2), neovascular glaucoma (n = 1). All cases had been surgically treated with at least one primary procedure (trabeculotomy, goniotomy, trabeculectomy, shunt surgery, cyclodestructive procedure). After identifying the refractory nature of the glaucoma, all cases underwent “safe” trabeculectomy supplemented with MMC (0.5 mg / 5 minutes of trans-operative subconjunctival exposure). Using standard definition of surgical success / failure, Kaplan-Meier survival analysis was used to estimate surgical outcomes in cases which were followed up for at least three years.
Medical chart information derived of 31 eyes from 26 patients (16 females, 10 males; mean age: 7.8 ± 5.1 years) was included in the analysis. All eyes had received a primary glaucoma procedure to treat different types of glaucoma. A diversity of reasons was reported by the treating surgeon to decide for a new glaucoma intervention. Pre-trabeculectomy mean IOP was 25.4 ± 5.3 mm Hg. Overall success rate (figure 2) with trabeculectomy supplemented with high dose of MMC was 94%, 90%, 87%, and 79%, at the 6-month, 12-month, 24-month, and 36-month post-operative moments, respectively. Mean post-operative IOP was 10.7 ± 2.8 mm Hg (P = 0.001), 13.1 ± 3.0 mm Hg mm Hg (P = 0.001), 15.4 ± 3.2 mm Hg (P = 0.001), and 14.9 ± 3.3 mm Hg (P = 0.001) after 6, 12, 24 and 36 months after trabeculectomy, respectively. Cumulative complication rate was 17% (most commonly, early / transient hypotony, anterior chamber shallowing, and bleb scarring). No catastrophic complication was recorded.
Our findings demonstrated that trabeculectomy supplemented with a high dose of MMC is a good surgical alternative to treat diverse types of pediatric refractory glaucomas. Randomized controlled clinical trials comparing trab. + MMC vs. glaucoma drainage implants are warranted.
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