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Impressum
Trabeculectomy for complicated forms of glaucoma: Topical application of mitomycin
Mietz H., Jacobi P. C., Krieglstein G. K.
Department of Ophthalmology, University of Cologne, 50931 Koeln, Germany
Objective: To assess the efficacy of a new application technique
of mitomycin to enhance the outcome of filtering surgery in cases of complicated
glaucoma.
Methods: This is a prospective, randomized clinical trial. Fifty
consecutive patients scheduled for glaucoma surgery in one large surgical
center were operated on. Patients underwent routine trabeculectomy. In
group 1, mitomycin (0.05mg/ml) was applied topically to the filtering
bleb on the three days after surgery (postoperative application). In group
2, mitomycin (0.2mg/ml) was applied to a sponge during surgery (intraoperative
application). Pre- and post- operative IOP values, visual acuity, the
need for antiglaucomatous medication, previous surgical procedures and
the need for further surgical interventions were monitored.
Results: Sufficient follow-up data was available from 24/25 patients
in both groups. Follow- up was 18.2 and 16.4 months, respectively. The
mean intraocular pressure decreased from 27.3 to 16.1mmHg in group 1 and
from 29.0 to 17.5mmHg in group 2. The average number of medications decreased
from 2.3 and 2.3 to 0.9 and 0.8 (p=0.68; t-test) in groups 1 and 2, respectively,
at the last visit. Success rates and complications were not significantly
different between the two groups. Hypotony was more frequent in group
2, where the only case of hypotony maculopathy occurred. The rate of loss
of visual acuity of more than two lines was higher in group 2. Failures
were more frequent in group 2 (7/24) as compared to group 1 (1/24) (p=0.045,
Log-rank test).
Conclusions: The postoperative application of mitomycin was similarly
effective as compared to the intraoperative application. It appears that
the postoperative application of mitomycin is associated with a lower
rate of complications when used in eyes with complicated forms of glaucoma.