Long-term results of trabeculectomy with mitomycin C applied under the scleral flap

Kyprianou, Ioannis; Nessim, Maged; Kumar, Vinod; O’Neill, Eammon

doi:10.1007/s10792-007-9092-3

Cited by 7 publications

(5 citation statements)

References 26 publications

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“…From these results, regardless of the trabeculectomy being with or without augmentation of antimetabolite, combined or not with cataract surgery, it appears to be a good way to lowering the IOP in Africans. The results of this study are consistent with findings from elsewhere, for instance, Ioannis Kyprianou et al found that with the longest follow-up period, trabeculectomy augmented with MMC under the scleral flap in difficult cases can achieve good long-term IOP control [31]. Leyland M et al found that the effect of 5FU has been reported with conflicting results such as showing no significant effect in other populations [32].…”

Section: Discussionsupporting

confidence: 91%

“…The large prospective studies such as Ocular Hypertension Treatment Study (OHTS) [38], Collaborative Normal Tension Glaucoma Study (CNTGS) [39] and Early Manifest Glaucoma Treatment Study (EMGTS) [40] have demonstrated that lower IOPs are associated with reduced risk for progresssion of visual field damage and visual loss [41]. Ioannis Kyprianou et al found the main reason for reduced vision was pre-existing co-morbidity and development of lenticular opacities [31]. In a study conducted by Stalmans et al, no change in visual acuity was noted: visual acuity before and at 1 month postoperatively was 0.67 (0.3) (range 0.01 -1) and 0.61 (0.3) (range 0.02 -1.0; p = 0.25) on average [42].…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of Trabeculectomy in Africa

Soatiana¹,

Kpoghoumou²,

Kalembo³

et al. 2013

OJOph

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Purpose:To determine the outcome of trabeculectomy in African countries. Design: This is a review of literature for trabeculectomy conducted in Africa from 2000 to December 2012. Methods: We conducted an electronic search from the following databases: PubMed, Science Direct, Google, and Google scholar websites for the articles of original studies on trabeculectomy conducted in Africa. Results: A total of 109 articles, published from 2000 to December 2012 were retrieved. Only 12 articles met our inclusion criteria and were included in the study. The follow-up duration ranged from 6 months to 60 months. The post-trabeculectomy IOP range was 10 mmHg to 22 mmHg with rates varying from 61.8% to 90%. The visual acuity was unchanged among 19% to 30% of the participants in the last follow-up, and the improvement rate was 36% to 81.5% while those whose condition worsened ranged from 8.9% to 30.8%. The cup-disc ratio was ≤0.5 in 13% and ≥0.8 in 83% of the participants. The failure rate of the c/d ratio was 0.9 and it increased by 0.027 units. There was a follow-up of only one study on the visual field. Conclusion: Trabeculectomy with or without application of antimetabolite appears to be a good way to lowering the IOP in Africa. In addition, the combined effect of trabeculectomy and cataract surgery produces visual benefits for the patients. c/d ratio = cup-disc ratio; IOP = intraocular pressure; VA = visual acuity; 5FU = 5 fluorouracil; MMC = mitomycin C; POAG = primary open angle glaucoma; NTG = normal tension glaucoma. 82 participants. Outcome of the cup-disc (c/d) ratio and the visual field post-operative. The follow-up of the c/d was only found in 3 studies. In these cases, the c/d ratio was ≤0.5 in 13% and ≥0.8 in 83%. There was a failure on the c/d ratio of 0.9 and this increased by 0.027 units [23]. And for the visual field, there was a follow-up for only one study.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Outcomes of Trabeculectomy in Africa

Soatiana¹,

Kpoghoumou²,

Kalembo³

et al. 2013

OJOph

View full text Add to dashboard Cite

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“… 5 Studies have shown that the use of MMC improves outcomes in glaucoma filtration surgery with good long-term IOP control. 6 - 8 Traditionally, MMC is applied by being soaked onto a surgical sponge and placed onto the scleral surgical site prior to creation of the ostomy, before or after formation of a partial thickness scleral flap. The sponge is removed after a variable amount of time depending on the surgeon’s preference, ranging from 30 seconds to 5 minutes.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Injection vs Sponge-applied Mitomycin C during Trabeculectomy: A One-year Study

Huang

2017

Journal of Current Glaucoma Practice

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AimTo determine the safety and efficacy of intraoperative injection of mitomycin C (MMC) against conventional sponge-applied MMC during trabeculectomy.Materials and methodsThis study was a retrospective, comparative case series. Thirty eyes with primary open-angle glaucoma underwent consecutive trabeculectomies with MMC injection (injection group), and thirty eyes with sponge-applied MMC were as controls (sponge group). Data were collected preoperatively and postoperatively at 1 day, 1 week, 1 month, 3 months, 6 months, and 1 year after surgery. Demographic data, applanation intraocular pressure (IOP), best-corrected visual acuity (VA), number of glaucoma medications, postoperative interventions, postoperative complications, and number of visits within 3 months were recorded. In order to stratify data, proportion of eyes achieving >30% IOP reduction from baseline with or without glaucoma medications was calculated and defined as surgical success.ResultsMean IOP reduction at 1 year was significant in both the injection and sponge groups from baseline (46.8 and 37.8% respectively). The injection group had overall lower postoperative IOP and comparable complete treatment success, defined as achieving >30% IOP reduction without glaucoma medications (p = 0.941). The number of postoperative visits within 3 months and the proportion of eyes needing 5-fluorouracil (5-FU) intervention were significantly lower in the injection group (p = 0.03, p = 0.04 respectively).ConclusionInjection of MMC was as safe and effective as sponge application with comparable estimated complete treatment success, less need for visits within 3 months, and 5-FU intervention.Clinical significanceSurgeons may consider intraopera-tive injection of MMC in appropriate patient cohorts given comparable safety and efficacy and several advantages over traditional sponge application. Further study in a prospective, larger, long-term manner is necessary to assess this modality.How to cite this article: Khouri AS, Huang G, Huang LY. Intraoperative Injection vs Sponge-applied Mitomycin C during Trabeculectomy: One-year Study. J Curr Glaucoma Pract 2017;11(3):101-106.

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“…The success rate for an IOP of <21 mmHg is reportedly 60–83% at 5 years, 15–73% at 10 years (Kyprianou et al. ), 42–48% at 15 years (Wilensky & Chen ; Chen et al. ) and 57–88% at 20 years (Landers et al.…”

Section: Discussionmentioning

confidence: 99%

Long‐term results of up to 12 years of over 700 cases of viscocanalostomy for open‐angle glaucoma

Grieshaber

Peckar

Pienaar

et al. 2014

Acta Ophthalmologica

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ABSTRACT.Purpose: To study the safety and long-term efficacy of classic viscocanalostomy in patients with open-angle glaucoma (OAG) in different populations. Methods: A total of 726 eyes of 726 patients from Europe or South Africa with primary OAG (POAG) and pseudoexfoliative glaucoma (PXFG) were included in this retrospective multicentre study. Complete (qualified) success was defined as an intraocular pressure (IOP) equal to or lower than 21, 18 and 16 mmHg without (with or without) medications, respectively. A failed procedure was defined if IOP was above 21 mmHg, not controllable by laser goniopuncture or medications. Results: The mean IOP before surgery was 42.6 AE 14.2 mmHg for all patients, 29.6 AE 6.6 mmHg for European patients and 48.1 AE 12.9 mmHg for African patients. The follow-up time was 86.2 AE 43.1 months. Mean IOP was 15.4 AE 3.6 mmHg at 5 years, 15.5 AE 4.4 mmHg at 10 years and 16.8 AE 4.2 mmHg at 15 years. The qualified success rate for an IOP of 21, 18 or 16 mmHg or less after 5 years was 92% [95% confidence interval (CI) 0.88-0.96], 70% (95% CI 0.63-0.77) and 43% (95% CI 0.36-0.51) in European patients, and 90% (95% CI 0.87-0.93), 77% (95% CI 0.74-0.81) and 67% (95% CI 0.63-0.72) in African patients, respectively. There was no difference between the success rate for POAG and PXFG for an IOP of 21, 18 or 16 mmHg or less at 5 years (p = 0.64, p = 0.20, p = 0.22, respectively). Laser goniopuncture was performed postoperatively on a total of 127 eyes (17.7%), lowering the pressure from 23.1 AE 1.9 mmHg to 15.0 AE 2.2 mmHg. There were no significant complications, in particular, no blebitis or endophthalmitis. Conclusion: Viscocanalostomy produced a sustained long-term reduction of IOP with a low-risk profile in European and African patients with OAG over 12 years.

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Long-term results of trabeculectomy with mitomycin C applied under the scleral flap

Abstract: In the series with the longest follow-up period our study showed that trabeculectomy augmented with MMC under the scleral flap in these difficult cases can achieve good long-term IOP control and is associated with minimal long-term complications.

Cited by 7 publications

References 26 publications

Outcomes of Trabeculectomy in Africa

Outcomes of Trabeculectomy in Africa

Intraoperative Injection vs Sponge-applied Mitomycin C during Trabeculectomy: A One-year Study

Long‐term results of up to 12 years of over 700 cases of viscocanalostomy for open‐angle glaucoma

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