Safety of trabeculectomy with mitomycin C: The ReGAE (research into glaucoma and ethnicity) experience

Abstract

Purpose To describe the prevalence of surgical complications in patients undergoing trabeculectomy with mitomycin C (trab + MMC). Methods A Review of an open consecutive prospective interventional case series performed by a single surgical team was undertaken. The case mix was a supra‐regional complex mixture of primary, secondary and paediatric glaucoma. Complete and qualified success rates, and the prevalence of complications were calculated. Results 382 eyes of 298 patients were included in the study. Mean follow up was 3.08 years. Mean age was 57.4 years (range: 6‐87). At latest follow up qualified success (IOP ≤ 21mmhg with ≥1 ocular hypotensive agent) was 95.7% (360 eyes) and complete success (IOP ≤ 21mmhg without an ocular hypotensive agent) was 84.8% (319 eyes). Early postoperative complications ≤1 month of surgery were reported in 21 (5.5%) eyes. 7 (1.8%) eyes developed late surgery related complications >1 month of surgery. Clinically significant early hypotony (IOP <6 on 2 separate occasions and requiring surgical intervention) occurred in 17 (4.5%) eyes. 2 patients developed late hypotony including 1 case of hypotony maculopathy, and there was 1 case each of toxic anterior segment syndrome, corneal decompensation plus cystoid macular oedema (ICE syndrome patient), blebitis, endophthalmitis, aqueous misdirection, suprachoroidal haemorrhage, retinal tear, and epiretinal membrane. No patients developed choroidal neovascularisation or malignant glaucoma. 1 patient developed pulmonary oedema after general anaesthesia. Conclusion Trab + MMC in a complex supra‐regional case mix service is a highly effective and safe operation. Only 3 (0.8%) eyes developed irreversible vision loss > 2 lines Snellen.