Long-term Follow-up after Initial Trabeculectomy with Mitomycin C: Intraocular Pressure Control and Late-onset Complications

Abstract

Abstract: : Purpose: To study intraocular pressure (IOP) control and late-onset postoperative complications after initial trabeculectomy with mitomycin C in Japanese glaucoma patients. Methods: In 79 eyes of 57 primary open angle glaucoma patients with no history of preceding glaucoma surgery, in which trabeculectomy was performed between 1993 and 1996, the clinical records were retrospectively reviewed. Control of IOP and the incidence of postoperative complications, such as aqueous leakage, infectious blebitis, and endophthalmitis, were analyzed using the Kaplan-Meier life table method. Failure in the life table analysis for IOP control was defined as the time point when IOP was higher than 30% reduction of the preoperative maximum IOP at three consecutive visits. Failure for the postoperative complications was defined as the time point when they were initially found. Results: During the preoperative period, the maximum IOP was 26.5 ± 5.5 (mean ± SD of the 79 eyes) mmHg and the averaged IOP was 21.0 ± 4.0 mmHg. If the cases underwent additional surgeries for IOP control or postoperative complications were excluded, the postoperative follow up periods were at least 5 years and averaged to 6.2 ± 1.8 years. The survival rate regarding IOP control was 58.4 ± 6.3 (mean ± SEM) % at 6 years after surgery. When the censored cases were excluded, postoperative IOPs averaged to 11.6 ± 4.6, 12.6 ± 4.4, and 11.3 ± 3.4 mmHg at 1, 3, and 6 years after surgery, respectively. The incidences of aqueous leakage and blebitis, which were calculated by the life table method, were 10.2 ± 5.6 % and 9.9 ± 5.1 % at 6 years after surgery, respectively. There was no eye developing endophthalmitis. Conclusions: Successful IOP control was obtained in about 60 % of the eyes for over 6 years after initial trabeculectomy with mitomycin C, which was likely to be slightly better than the results after trabeculectomy with 5-fluorouracil.¹ The current results that aqueous leakage and blebitis were observed in about 10 % of the eyes, respectively, suggest the importance of careful follow-up of the postoperavie eyes over a long period. ¹: Uchida S, Suzuki Y, Araie M, et al. Long-term follow-up of initial 5-fluorouracil trabeculectomy in primary open-angle glaucoma in Japanese patients. J Glaucoma 2001;10:458-65.

Keywords: clinical (human) or epidemiologic studies: out • intraocular pressure