Comparison between Results of Trabeculectomy in Primary Congenital Glaucoma with and without the Use of Mitomycin C

Rodrigues, Adriana Maria; Júnior, Augusto Paranhos; Montezano, Fabio; Melo, Paulo de Arruda; Júnior, João J. Nassaralla

doi:10.1097/00061198-200406000-00010

Cited by 47 publications

(29 citation statements)

References 28 publications

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“…24,47 Antimetabolites such as mitomycin C or 5-fluorouracil can be applied to prevent excessive scar formation; however, some authors report a higher risk of complications in the paediatric population compared to adults. [48][49][50] Postoperative complications after AVI include hypotony (IOPp5 mm Hg) (11-42%), shallow anterior chamber (15 B26%), tube malposition (5B26%), tubecorneal touch (3B8%), tube occlusion (14%), tube exposure (6B12%), and other rare complications such as tenon encapsulated cyst (1B7%), postoperative cataract (0B2%), strabismus (0B3%), retinal or choroidal detachment (1B18%), endophthalmitis (1B5%), wound leak (3%), plate migration (2%), inflammation, hyphema, delayed retrobulbar haemorrhage. [28][29][30]33,39,51,52 In our study, overall rates of complications was lower than previously reported.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes after Ahmed valve implantation in refractory paediatric glaucoma

Yang

Park

2008

Eye

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Purpose To evaluate clinical outcomes after Ahmed valve implantation in refractory paediatric glaucoma. Methods A retrospective review was conducted on 34 eyes from 29 patients with refractory glaucoma, who were younger than 18 years of age and who underwent Ahmed valve implantation. The main outcome measures were intraocular pressures (IOPs) and the number of glaucoma medications used. Qualified success was defined as IOP p21 mm Hg regardless of the number of glaucoma medications. Complete success was defined as IOP p21 mm Hg without glaucoma medication.Results Mean age at operation was 5.5 years (range, 0-16). Fifteen eyes (44.1%) had undergone previous glaucoma surgery before Ahmed valve implantation. Mean follow-up time was 29.1 months (range, 3-31). IOP was reduced from a preoperative mean of 37.5 ± 7.3 to 18.4 ± 7.3 mm Hg at 6 months postoperatively (Po0.01). At 12 months after surgery, the success rates were 63.3% (qualified success) and 13.3% (complete success). The cumulative probabilities of qualified success at 6, 12, and 24 months after Ahmed valve implantation were 89.0, 68.6, and 45.7%, respectively. The median time of survival was 19.6 ± 0.9 months. Conclusions Ahmed valve implantation is effective in lowering IOP in refractory paediatric glaucoma, with limited survival after long-term follow-up. Addition of a second Ahmed valve may be effective in the management of failure after primary implantation.

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes after Ahmed valve implantation in refractory paediatric glaucoma

Yang

Park

2008

Eye

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“…There have been few reports on the use of Mitomycin-C (MMC) during trabeculectomy in childhood glaucoma. [12][13][14][15][16] Despite achieving good results with the use of MMC, it is not recommendable its use in children with early postnatal period because long-term results and complications of MMC use are not yet known.…”

Section: Discussionmentioning

confidence: 99%

Success of trabeculotomy in patients with congenital glaucoma operated on within 3 months of birth

Yalvaç¹,

Şatana²,

Suveren³

et al. 2006

Eye

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Aims To determine the efficacy and safety of trabeculotomy in congenital glaucoma patients operated on within first 3 months of birth. Methods A total of 36 eyes of 24 patients with congenital glaucoma, who underwent primary trabeculotomy within first 3 months of birth were included. Preoperative and postoperative intraocular pressures (IOP), corneal clarity, diameter, axial length, success rates, and complications were evaluated in this study.Results The mean follow-up was 38.38711.77 months (range 12-48 months). Mean IOP was 33.1677.28 mmHg (range 23-50 mmHg) preoperatively. At the final follow-up visit, the mean IOP was 21.4177.34 mmHg (range 8-38 mmHg). Pre-and postoperative IOP differences were statistically significant at all examination periods (Po0.001). A12-, 24-, and 36-month success rates were 92, 82, and 74%, respectively. Survival analysis regarding to gender, preoperative corneal diameter and consaguinity were not statistically significant. Only preoperative axial length was a statistically significant parameter (P ¼ 0.024) for success. Postoperatively normal corneal clarity was achieved in 29 eyes (80.5%). The main complications were shallow anterior chamber in one (4.2%) eye and detachment of Descement's membrane in two (8.4%) eyes. Conclusions Primary trabeculotomy is a safe and effective procedure for congenital glaucoma patients when operated within 3 months of birth. It has a favourable IOP control and a low rate of complications in three year period.

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“…2,3 Primary congenital glaucoma is the most common of the childhood glaucomas. 4 A variety of surgical procedures have been used for the treatment of primary congenital glaucoma, including goniotomy (for cases of clear cornea), 5 trabeculotomy, 6 trabeculectomy, 3,7,8 and glaucoma drainage devices. 8 The use of wound-modulating agents, including antimetabolites such as 5-flourouracil and mitomycin C, has added to the success of filtering surgery in pediatric glaucoma.…”

Section: Introductionmentioning

confidence: 99%

“…8 The use of wound-modulating agents, including antimetabolites such as 5-flourouracil and mitomycin C, has added to the success of filtering surgery in pediatric glaucoma. 3,7,9 Of particular interest, lately the procedures for primary congenital glaucoma are combined, 10,11 especially trabeculotomy-trabeculectomy with mitomycin C, with variably reported success rates. 1,11,12 Childhood glaucoma is more common and more severe in communities with higher consanguineous marriages, such as in Romanian Gypsies and in the Saudi Arabian population.…”

Section: Introductionmentioning

confidence: 99%

Deep sclerectomy in pediatric glaucoma filtering surgery

Bayoumi

2012

Eye

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Purpose To study the additive value of deep sclerectomy to the procedure of combined trabeculotomy-trabeculectomy with mitomycin C (CTTM) for the treatment of primary congenital glaucoma. Study design This study is a prospective, randomized case series. Patients and methods The study was conducted on 20 eyes of 20 children with primary congenital glaucoma presenting to the Department of Ophthalmology of the Alexandria Main University Hospital. Preoperative examination under anesthesia was followed by surgical intervention. Postoperative examinations were conducted immediately after surgery and at 1, 2, 3, 6, 9, and 12 months. Intraoperative and postoperative complications, as well as operative time, were recorded. Results The mean (±SD, range) age of the study patients in the CTTM group and in the combined trabeculotomy-trabeculectomy with mitomycin C with deep sclerectomy (CTTM-DS) group was 4.7 ( ± 2.0, 2-8) and 7.0 ( ± 3.8, 3-13) months, respectively. The mean ( ± SD, range) preoperative intraocular pressure (IOP) in the CTTM and CTTM-DS groups was 16.7 (4.3, 10-26) and 16.4 (8.4, 8-36), respectively, and these dropped at 12 months of follow-up to 4.9 (2.0, 2-8) and 5.6 (3.3, 2-10), respectively. The mean ( ± SD, range) of the duration of the operation in the CTTM and the CTTM-DS was 57 ( ± 8, 50-71) min and 53 ( ± 7, 42-64) min, respectively (P ¼ 0.428). Two eyes (20%) in the CTTM-DS group developed hypotony disc edema at the first 2 months and resolved spontaneously thereafter. No other complications were noted in either of the groups. Conclusion The addition of deep sclerectomy to the procedure of CTTM in pediatric glaucoma surgery facilitates the finding of Schlemm's canal, shortens the duration of surgery, and is not associated with any additional complications. Hence, the author recommends the addition of deep sclerectomy to CTTM surgery for primary congenital glaucoma.

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Comparison between Results of Trabeculectomy in Primary Congenital Glaucoma with and without the Use of Mitomycin C

Abstract: The success of trabeculectomy for primary congenital glaucoma with mitomycin C was not different than that of trabeculectomy with mitomycin C in the studied patients. Mitomycin C was associated with a higher incidence of complications.

Cited by 47 publications

References 28 publications

Clinical outcomes after Ahmed valve implantation in refractory paediatric glaucoma

Clinical outcomes after Ahmed valve implantation in refractory paediatric glaucoma

Success of trabeculotomy in patients with congenital glaucoma operated on within 3 months of birth

Deep sclerectomy in pediatric glaucoma filtering surgery

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