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Anuradha Jayaprakasam, Freda Sii, Pavi Agrawal, Peter Shah; Safety And Efficacy Of Primary Trabeculectomy With Mitomycin C In Juvenile Open Angle Glaucoma - 3 Year Results. Invest. Ophthalmol. Vis. Sci. 2011;52(14):630.
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Juvenile open angle glaucoma is a rare, open angle glaucoma that represents less than 1% of all glaucomas. It occurs in patients between the age of 3 and 35 years. These patients often achieve very high intraocular pressures and become rapidly resistant to topical therapy, necessitating surgery. We present the safety and efficacy data of our prospective cohort of juvenile open angle glaucoma patients undergoing primary trabeculectomy with mitomycin C, with a follow up of 3 years.
A non-comparative, prospective cohort study of 17 eyes of 12 patients with juvenile open angle glaucoma, undergoing primary trabeculectomy with MMC, between the ages of 3 and 35 years. Qualified and unqualified success rates were stratified for IOPs ≤ 21mmHg, 18mmHg and 15mmHg for a follow-up period of 3 years.
Of 17 eyes (10 male, 7 female), 4 were Caucasian, 7 were African-Caribbean and 6 were Asian. The mean age of patients at the time of surgery was 26 years (range 13-33 years). 12 eyes have 3 year follow-up. The mean highest pre-operative pressure was 39.2 mmHg. Immediate pre-operative IOP was 25.8 mmHg on a mean of 4.5 IOP lowering agents, reducing to 10.2 mmHg at 1 month and 13.3 mmHg on a mean of 0 medications at 3 years post-operatively. At 3 years post-operatively, qualified success was achieved in 100 %, 100 % and 83 % for IOPs ≤ 21 mmHg, 18 mmHg and 15 mmHg, respectively and unqualified success in 83 %, 83 % and 75 % respectively. Complications included clinically significant early hypotony in 3 eyes, with need for re-suturing in 3 eyes, and need for bleb-needling revision within 3 months in 2 eyes. There were no cases of loss of vision > 2 Snellen lines, or endophthalmitis.
Patients with juvenile open angle glaucoma tend to have lower success and higher complication rates compared to those of primary open angle glaucoma. However, with appropriate pre-operative strategies, modified intra-operative techniques and aggressive post-operative management, it is possible to achieve high success rates and maintain good visual function even in this difficult to treat group.
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