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Outcomes of Primary Trabeculectomy With the Use of Adjunctive Mitomycin
Ingrid U. Scott, MD, MPH;
David S. Greenfield, MD;
Joyce Schiffman, MS;
Marcelo T. Nicolela, MD;
Juan C. Rueda, MD;
James C. Tsai, MD;
Paul F. Palmberg, MD, PhD
Arch Ophthalmol. 1998;116:286-291.
Objective To investigate the efficacy and safety of adjunctive mitomycin when used during a primary trabeculectomy within a series of 89 consecutive patients at 1 and 2 years postoperatively.
Design A cohort study of all patients who underwent primary trabeculectomy, performed by one of us (P.F.P.), between April 1, 1991, and December 31, 1994. Patients received topical mitomycin in conjunction with a corneal safety valve incision. A trabeculectomy was considered "successful" if it resulted in an intraocular pressure (IOP) of 21 mm Hg or lower and a 30% or greater reduction in the IOP at and after 1 year of follow-up, with or without medications and without a reoperation for an elevated IOP. Survival analysis was used to calculate success rates.
Results The 1- and 2-year success rates were 85.4% and 77.9%, respectively. The mean IOP was reduced from 26.3 to 11.3 mm Hg at 1 year (n=68) and to 11.9 mm Hg at 2 years (n=56), with 60 (88.2%) of 68 patients off medication at 1 year and 47 (83.9%) of 56 patients off medication at 2 years. Trabeculectomy success rates were significantly lower in black compared with nonblack patients (76.2% vs 87.5% at 1 year, P=.03). Trabeculectomy failure occurred throughout the follow-up period. Endophthalmitis occurred in 2 (2.2%) of the patients, and hypotonia requiring revision occurred in 4 (4.5%) of the patients.
Conclusions Primary trabeculectomy with the use of intraoperative mitomycin lowered the IOP by 30% or more in 78% (at 2 years) to 86% (at 1 year) of the cases and is associated with a marked reduction in the percentage of patients who require glaucoma medication. Success rates must be evaluated in light of such risks as endophthalmitis and hypotony.
From the Departments of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Fla (Drs Scott, Greenfield, and Palmberg and Ms Schiffman), University of Sao Paulo, Sao Paulo, Brazil (Dr Nicolela), and Vanderbilt University, Nashville, Tenn (Dr Tsai); and Fundacion Oftalmologia Santander, Bucaramanga, Colombia (Dr Rueda).
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