Outcome of consecutive trabeculectomy

Abstract

Trabeculectomy outcome in paired eyes of patients was similar in both antimetabolites treated and untreated eyes. Thus, trabeculectomy outcome in the first operated eye can predict the surgical result in the second eye of the same patient.

Trabeculectomy with brief exposure to mitomycin C

“…Success rates (IOP < 21 mmHg) of primary trabeculectomy are reported to be approximately 85% at 15 years postoperatively 12,13 , 15,19–24 . The use of antimetabolites, MMC or 5‐FU results in higher success rates and prolonged longevity of up to 12 years postoperatively 1,5 , 14,25 .…”

“…Trabeculectomy with adjunctive use of MMC 0.2–0.4 mg/mL for 1–3 min yields success rates of 60–90%; studies with longer follow up may report lower success rates (Table 3). 1,2 , 5,12 Hypotony is reported in up to 20%, but the risk of bleb related endophthalmitis is usually low and reported to be 0–3%. We achieved a comparable success rate (73% complete success and 94% qualified success) with brief exposure to MMC and had no severe complications such as bleb leak or bleb‐related endophthalmitis.…”

“…Anti‐metabolites have been associated with possible complications including hypotony, wound leakage and endophthalmitis, occurring more frequently with MMC than 5‐FU 9–11 . Concentration of MMC ranged from 0.1 to 0.5 mg/mL, with 0.2 mg/mL being the most favoured dosage and 1–3 min the most common duration 1,2 , 5,12 , 13 . Application durations ranged from 1 min to longer than 5 min, with the average duration of 2–4 min 5,14 , 15 .…”

“…Application durations ranged from 1 min to longer than 5 min, with the average duration of 2–4 min 5,14 , 15 . Longer applications of MMC to tenon’s space may be associated with a higher risk of complications, secondary to a greater antifibrotic effect achieved yet not associated with higher success rates 1,2 , 5,12 , 13 …”

Comparison of the Outcome of Repeat Trabeculectomy with Adjunctive Mitomycin C and Initial Trabeculectomy

“…Broadway et al [9] found that the previous conjunctival surgery induced the general increase in subepithelial conjunctival fibroblasts. Zalish et al [10] suggest that the outcome of trabeculectomy is highly influenced by the patients wound healing characteristics. Therefore eyes undergoing repeat surgery can be accepted "at risk" because they have already failed at least once.…”