May 2004
Volume 45, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2004
Long–term outcome of MMC vs 5FU trabeculectomy in uveitic glaucoma
Author Affiliations & Notes
  • K. Barton
    Glaucoma Uveitis Clinic,
    Moorfields Eye Hospital, London, United Kingdom
  • W.A. Franks
    Glaucoma Uveitis Clinic,
    Moorfields Eye Hospital, London, United Kingdom
  • C. Bunce
    Research & Development,
    Moorfields Eye Hospital, London, United Kingdom
  • R. Lauande–Pimentel
    Glaucoma Uveitis Clinic,
    Moorfields Eye Hospital, London, United Kingdom
  • V. Maurino
    Glaucoma Uveitis Clinic,
    Moorfields Eye Hospital, London, United Kingdom
  • C.E. Pavesio
    Medical Retinal Service,
    Moorfields Eye Hospital, London, United Kingdom
  • S.L. Lightman
    Clinical Ophthalmology,
    Moorfields Eye Hospital, London, United Kingdom
  • Footnotes
    Commercial Relationships  K. Barton, None; W.A. Franks, None; C. Bunce, None; R. Lauande–Pimentel, None; V. Maurino, None; C.E. Pavesio, None; S.L. Lightman, None.
  • Footnotes
    Support  none
Investigative Ophthalmology & Visual Science May 2004, Vol.45, 991. doi:
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      K. Barton, W.A. Franks, C. Bunce, R. Lauande–Pimentel, V. Maurino, C.E. Pavesio, S.L. Lightman; Long–term outcome of MMC vs 5FU trabeculectomy in uveitic glaucoma . Invest. Ophthalmol. Vis. Sci. 2004;45(13):991.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Abstract: : Purpose: To clarify whether the greater IOP lowering achieved by MMC as compared to 5FU trabeculectomy in uveitis is maintained in the long–term. Methods: Prospective comparative interventional study of 42 consecutive eyes with uveitic glaucoma who had a first trabeculectomy with either MMC or 5FU in alternate cases between 1995 – 1998. Second eyes and second trabeculectomies were excluded. Medium term data presented previously, demonstrated a significant benefit with MMC over 5FU in IOP control at 45months (median) follow–up. However, this advantage was observed to be diminishing with time. Long–term follow–up of the same study is reported. Results:After exclusion of 3 eyes lost to follow–up in the first year, 39 first eyes (21 with MMC (0.2mg/ml) and 18 with 5FU (25mg/ml)) were followed for 69 ± 6 months (mean ± SEM) after surgery. Preoperative data included IOP 30 ± 0 mmHg, Medications 2.59 ± 0.13, Cup–disc ratio (CD) 0.70 (0.20 – 0.90), Visual acuity (VA) 6/12 (median)(range 6/6 – CF). Last postoperative follow–up data included IOP 14 ± 1 mmHg, Medications 0.4 ± 0.1, CD 0.65 ± 0.05, VA 6/12 (6/5 – NPL). Absolute success (IOP <22mmHg without medications at last follow–up) was now slightly superior in the 5FU group (61% 5FU, 57% MMC)(NS). Qualified success (IOPl < 22mmHg with or without topical medications) remained higher with MMC (84%) than 5FU (67%)(NS). Seven eyes (failures) were uncontrolled at last follow–up or underwent further surgery for IOP. Four were pseudophakic or aphakic preoperatively. The remaining 3 had undergone subsequent cataract surgery. No failures occurred in patients who were phakic at last follow–up. Survival analysis demonstrates that this trend was independent of follow–up. Conclusions: We previously reported a significantly improved medium–term survival in terms of IOP control in patients with uveitic glaucoma having MMC compared to 5FU trabeculectomy. This benefit has lost significance in the same study with long term follow–up suggesting that MMC delays but does not prevent trabeculectomy failure in some patients with ongoing inflammation. Though significance was not demonstrated, all failures occurred in eyes that were either already pseudophakic, aphakic or underwent later cataract surgery. Though this trend may represent an elevated risk of trabeculectomy failure directly attributable to cataract surgery, it is also likely that both cataract surgery and trabeculectomy failure are more common in eyes with more aggressive uveitis.

Keywords: wound healing • uvea • anterior segment 
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