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Philip P Chen, Kristy Moeller; Small-incision revision of trabeculectomy with mitomycin: outcomes and complications. Invest. Ophthalmol. Vis. Sci. 2018;59(9):470. doi: https://doi.org/.
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To assess outcomes and complications of small-incision trabeculectomy revision with mitomycin (MMC) in glaucoma patients.
Trabeculectomy revision with MMC was performed for inadequate intraocular pressure (IOP) control. After dissection of subconjunctival fibrosis through a small (median 5 mm) incision, MMC was topically applied and episcleral fibrosis was incised. Failure was defined as reoperation for glaucoma, or IOP reduction < 20% over 3 follow up visits.
Forty eyes (40 patients; mean age 67 ± 13 years) underwent revision; 10 cases were combined with other surgery. Mean baseline IOP was 20.6 ± 6.2 mmHg on 2.6 ± 1.4 glaucoma medications after 2.4 ± 1.3 incisional ocular surgeries. At final follow-up (63 ± 33 months), 28 successful eyes (70%) had IOP of 9.3 ± 2.7 mmHg on 0.6 ± 0.9 medications. Ten eyes (25%) required reoperation for glaucoma, 7 within 7 months after revision. The Kaplan-Meier estimate of success at years 1, 2, 3, and 5 postoperatively was 78%, 75%, 72% and 68% respectively. Recovery of visual acuity to within 2 lines of baseline was 1.7 ± 2.4 weeks (median 1). Complications included sustained hypotony (IOP ≤ 5 mmHg) in 2 eyes (5%), requiring revision in one eye that also had corneal decompensation, and wound leak and bleb leak requiring repair in 1 eye each.
Small-incision trabeculectomy revision with MMC results in substantial, sustained IOP reduction in most eyes with poorly functioning filtering blebs, with few serious complications and rapid recovery of baseline visual acuity in most eyes.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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