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K. Ishida, E.E. Benz, J.C. Schiffman, P.F. Palmberg; Long-term Results of Primary Filtering Surgery with Adjunctive Antimetabolites . Invest. Ophthalmol. Vis. Sci. 2003;44(13):2170.
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Purpose: To investigate the long-term efficacy and safety of primary trabeculectomy with mitomycin-C (MMC) or 5-fluorouracil (5-FU). Methods: All patients (212 eyes from 173 patients) who underwent primary trabeculectomy, performed by one of us (PP), between Jan 1989, and Dec 1995, were asked to come annually for follow up exams, now analyzed retrospectively. 119 eyes (56.1%) were in white, 37eyes (17.5%) in black and 56 eyes (26.4%) in Hispanic patients; 191 eyes (90.1%) had primary or secondary open-angle glaucoma; 21 eyes (9.9%) had angle closure glaucoma. Results: The mean intraocular pressure (IOP) was reduced from 26.1mmHg to 10.5 at 4 years (n=125), to 10.9 at 7 years (n=81) and to 11.0 at 10 years (n=30)), irrespective of additional interventions. Success rates were calculated, respectively, by three criteria. Criterion 1 was defined as eyes without a reoperation, Criterion 2; eyes without a reoperation and with an IOP<=21mmHg without medications, and Criterion 3; eyes without a reoperation and IOP<=15 mmHg without medications. The average changes from baseline in Mean deviation (MD) and Pattern standard deviation (PSD) are given below. Hypotony maculopathy occurred in 5.6% of eyes. The incidence of leaking bleb at any time > 1 month postoperatively was 11.8% (n=25). Blebitis and endophthalmitis occurred in 8 eyes (3.8%) and in 6 eyes (2.8%), respectively. The proportion infection free was 95% at 5 years and 92% at 10 years. Conclusion: Patients operated upon with adjunctive MMC or 5-FU in initial glaucoma surgery generally achieved good long-term control of glaucoma, with on average no progression of visual field loss. However, such success must be weighed against complications, including hypotony maculopathy and bleb-related infection. View OriginalDownload SlideView OriginalDownload Slide
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