Trabeculectomy with brief exposure to mitomycin C

Simon, Guy J. Ben; Glovinsky, Yoseph

doi:10.1111/j.1442-9071.2006.01305.x

Cited by 8 publications

(15 citation statements)

References 21 publications

(54 reference statements)

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“…Even though the use of antimetabolites like MMC to modulate wound healing and bleb fibrosis has increased the success rate of filtration surgery, it has been associated with more complications including hypotony, wound leakage and endophthalmitis [32,33,34,35,36,37,38,39]. Because the recent studies proposed that shorter duration and lower MMC concentration may result in similar inhibition of fibroblast proliferation, recently most glaucoma surgeons have used the lower doses of MMC and applied it for a shorter time than in early protocols [40,41,42,43,44,45,46,47]. …”

Section: Discussionmentioning

confidence: 99%

Long-Term Intraocular Pressure Control of Trabeculectomy and Triple Procedure in Primary Open Angle Glaucoma and Chronic Primary Angle Closure Glaucoma

Hong

Park

et al. 2007

Ophthalmologica

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To evaluate the long-term intraocular pressure (IOP) control of trabeculectomy and triple procedure (cataract extraction by phacoemulsification, intraocular lens implantation and trabeculectomy), 1,542 eyes of 900 patients with primary open angle glaucoma (POAG) or chronic primary angle closure glaucoma (CPACG) were included. When success was defined as an IOP reduction of at least 30% from baseline, with or without antiglaucoma medications, the overall probability of success of trabeculectomy and triple procedure was 0.613 and 0.733 at 15 years, respectively. The success probability of trabeculectomy and triple procedure in reducing IOP below 18 mm Hg was 0.748 and 0.825 at 15 years, respectively. In POAG and CPACG patients, trabeculectomy and triple procedure were effective in reducing IOP for up to 15 years after surgery.

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Section: Discussionmentioning

confidence: 99%

Long-Term Intraocular Pressure Control of Trabeculectomy and Triple Procedure in Primary Open Angle Glaucoma and Chronic Primary Angle Closure Glaucoma

Hong

Park

et al. 2007

Ophthalmologica

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“…The rest of the 18 abstracts did not mention this important parameter. The preoperative number of medications was mentioned in only five abstracts, as “m”47,63 or as m ± SD 50,56,59. The postoperative number of medications appeared in ten abstracts, but the methods of transmitting this information were extremely varied, such as “m”,47,49,63 “m ± SD”,50,59 percentage,56 or using qualitative terms “no change”,52,62 or “lower number of medications” 58.…”

Section: Resultsmentioning

confidence: 99%

“…The preoperative number of medications was mentioned in only five abstracts, as “m”47,63 or as m ± SD 50,56,59. The postoperative number of medications appeared in ten abstracts, but the methods of transmitting this information were extremely varied, such as “m”,47,49,63 “m ± SD”,50,59 percentage,56 or using qualitative terms “no change”,52,62 or “lower number of medications” 58. Although all abstracts noted a favorable outcome, only 12 reported it in a quantitative manner, such as the number of patients out of the total,44,45,49,56 or as a percentage 51,52,58,60,62.…”

Section: Resultsmentioning

confidence: 99%

A new manner of reporting pressure results after glaucoma surgery

Bordeianu¹,

Ticu²

2011

OPTH

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PurposeTo evaluate to what extent contemporary glaucoma abstracts offer complete information and to suggest a new manner of pressure results reporting.Materials, methods, and resultsMost of the 36 relevant surgical glaucoma abstracts found in one issue of International Glaucoma Review contain insufficient data-supported statements. Such abstracts cannot offer a clear picture of the study essence if economic, linguistic, or political barriers prevent access to the full text. In order to enrich abstract content and to avoid typographic space waste, a formula is suggested to provide, in one single line of symbols and figures, all the necessary data for statistical interpretation at two evolution moments: the first significative control (6 months) and the final one.ConclusionThe current manner of results reporting in surgical glaucoma abstracts is subject to too little standardization, allowing insufficiently data-supported statements. Abstracts, especially those printed in small-circulation language journals, should be conceived and standardized in such a manner that any abstract review reader is capable of grasping the essence of the study at first glance. The suggested manner of reporting results would bring satisfaction to all areas of the process. Publishers would save typographic space, readers would find all the necessary data for statistical analysis and comparison with other studies, and authors would be convinced that the essence of their work would penetrate in spite of any economic, linguistic, or political barriers.

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“…The increased popularity of per-operative antifibrotics in the US preceded the UK and a survey of the American Glaucoma Society reported that MMC was used in 45% of primary trabeculectomies in 1996, this increasing to 68% by 2002 [38]. The reported dose and exposure times for MMC have varied considerably from 0.1 to 0.5 mg/ml and 15 seconds to 5 minutes respectively [37][38][39][40][41][42][43]. In the present study the vast majority of eyes were exposed to 5 minutes of 5-FU (25 mg/ml) or 3 minutes of MMC (0.2 mg/ml), this tending to be less exposure than in previous studies [37][38][39][40][41][42][43] despite the inclusion of patients with significant risk factors for failure, albeit that these latter cases were those where more MMC was utilised.…”

Section: Discussionmentioning

confidence: 99%

“…The reported dose and exposure times for MMC have varied considerably from 0.1 to 0.5 mg/ml and 15 seconds to 5 minutes respectively [37][38][39][40][41][42][43]. In the present study the vast majority of eyes were exposed to 5 minutes of 5-FU (25 mg/ml) or 3 minutes of MMC (0.2 mg/ml), this tending to be less exposure than in previous studies [37][38][39][40][41][42][43] despite the inclusion of patients with significant risk factors for failure, albeit that these latter cases were those where more MMC was utilised. It is possible that the relatively recent recommended change to use a wide posterior subconjunctival delivery of lower dose MMC for 2-3 minutes provides the optimal effect with minimal risk of adverse effects [9,10,13,44].…”

Section: Discussionmentioning

confidence: 99%

The Norwich Trabeculectomy Study: Long-term Outcomes of Modern Trabeculectomy with Respect to Risk Factors for Filtration Failure

Clark¹

2014

J Clin Exp Ophthalmol

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Objective: The aim of the study was to evaluate the long-term outcomes of a large series of 'modern' trabeculectomies with specific respect to traditional risk factors for failure. Methods: 636 consecutive 'modern', augmented 'safe-technique' trabeculectomies performed over an 11-year period (1998-2008) were assessed in a single centre, observational, cohort study. Traditional risk factors for failure (previous surgery, long-term exposure to topical medication, young age, secondary glaucoma and trainee surgeon) were assessed using various success outcome criteria. Success survival was defined with respect to various intraocular pressure (IOP) targets, using criteria for both complete and two categories of qualified success. A multivariate logistic regression analysis was performed to account for the significant number of patients with more than one risk factor. Results: The mean follow-up period was 65.5 (± 35.7) months. At final follow-up the mean IOP for all eyes was reduced from 23.4 (± 6.2) mmHg pre-operatively to 11.9 (± 4.2) mmHg (p<0.001) and the mean number of topical anti-glaucoma medications was reduced from 2.3 to 0.4 (p<0.001). Complete success rates were 65% (IOP ≤ 15 mmHg, no medications) and 71% (IOP ≤ 21 mmHg, no medications) at final follow-up. Qualified success rates varied from 78% to 97%, depending on IOP threshold. Outcomes for the various risk factor groups were compared with a 'risk-free' control group. Overall, traditional risk factors for failure did not significantly influence outcome for the various success criteria, but surgery performed by trainee surgeons had less satisfactory outcomes compared to surgery performed by a more senior surgeon. Clinic-based post-operative interventions were more frequently required in eyes with 'traditional' risk factors for failure. Conclusions: In a large cohort of mainly Caucasian patients, appropriately augmented, 'modern', 'safetechnique' trabeculectomy was highly successful and, together with 'modern' post-operative management, appeared to annul the effect of most 'traditional' risk factors for failure such as previous surgery, long-term exposure to topical medication, relative youth and secondary glaucoma.

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Trabeculectomy with brief exposure to mitomycin C

Abstract: Trabeculectomy with brief (15 s) exposure to MMC 0.4 mg/mL is safe and effective in lowering IOP in this group of patients, and results in low rate of postoperative complications. Success is comparable to reported data with longer exposure durations to antimetabolites.

Cited by 8 publications

References 21 publications

Long-Term Intraocular Pressure Control of Trabeculectomy and Triple Procedure in Primary Open Angle Glaucoma and Chronic Primary Angle Closure Glaucoma

Long-Term Intraocular Pressure Control of Trabeculectomy and Triple Procedure in Primary Open Angle Glaucoma and Chronic Primary Angle Closure Glaucoma

A new manner of reporting pressure results after glaucoma surgery

The Norwich Trabeculectomy Study: Long-term Outcomes of Modern Trabeculectomy with Respect to Risk Factors for Filtration Failure

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