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Friederike Mackensen, Bianca C. Dobner, Alexandra B. Knoll, Alexander F. Scheuerle, Klaus Rohrschneider; Outcome And Structural Evolution Of Mytomycin Assisted Trabeculectomy In Inflammatory Glaucoma. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5948.
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Secondary glaucoma in inflammatory eye disease is a severe and vision threatening complication. Local treatment is often not sufficient to control intraocular pressure (IOP). Surgical procedures are reported to have worse outcome than in non-inflammatory glaucoma. Worse outcome is said to be due to faster cicatrization, but so far little is known regarding morphological details. Microcysts shown by-in-vivo confocal microscopy are thought to be indicators of good bleb function, but have not been evaluated in inflammatory glaucoma. We aimed to evaluate our patient's outcome that were operated with mitomycin assisted trabeculectomy.
Success was defined as IOP ≤ 20 mmHg applanatory without additional treatment, relative success was defined as IOP ≤ 20 mmHg with additional treatment. Failure was defined as IOP rise requiring further surgical intervention. Successfully treated and failing patients were examined by two methods imaging the morphology of the filtering bleb: the anterior segment module (ASM) of the Spectralis OCT measuring the width of the sclerostomy and the Rostock Cornea Module (RCM) of the Heidelberg Retina Tomograph (HRT) (both Heidelberg Engineering) following a scale published by Labbé in 2008.
We operated on 28 eyes of 23 patients with trabeculectomy and mitomycin C 0.2 mg/ml. Postoperatively 5-FU Injections were given if needed. Median follow-up was 24 months (range 3.47 - 83.37). Most (59%) had anterior uveitis (associated with juvenile arthritis in 44%), followed by intermediate (19%) and Panuveitis (15%). Only 11 % had herpetic uveitis.Of these 28 eyes 20 (71.4%) were treated with absolute and 4 (14.3%) with relative success. Four blebs failed, one patient was a complete failure and three eyes required revision surgery that lead to absolute success in 2 and relative success in one eye. At one year postoperative (19 eyes) the mean IOP was 12.9 +/- 6.4, at 2 years (16 eyes) 11.1 +/- 4.9 and at three years (7 eyes) 13.4 +/- 5.4 mmHg. Morphological details that were associated with relative success were fewer microcysts and dense stroma as previously reported for non-inflammatory glaucoma. Measurements of the sclerostomy seem to be wider in good functioning blebs.
Overall outcome in our study of 86% success in those operated on once, was unexpectedly good in this cohort of inflammatory glaucoma. This may be due to consequent mitomycin use during trabeculectomy and postoperative treatment with 5-FU Injections when needed, and maybe as well to strict uveitis control by medical treatment. Morphological evaluation by ASM OCT and HRT RCM is helpful to link morphology to bleb function.
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