Non-penetrating glaucoma surgery augmented with mitomycin C or 5-fluorouracil in eyes at high risk of failure of filtration surgery: long-term results

PURPOSE: To investigate the long-term efficacy and safety of non-penetrating glaucoma surgery (NPGS) augmented with mitomycin C (MMC) or 5-fluorouracil (5FU) in eyes at high risk of failure of glaucoma filtration surgery. METHODS: Prospective study of all eyes, undergoing NPGS with 0.04% MMC (1 to 2 min topical or 0.04 mL subconjunctival injection into the superior fornix) or 5FU (25 mg/mL topically for 5 min). Complete success was an intraocular pressure (IOP)or=20% drop in IOP or a reduction of at least two medications. RESULTS: Twenty-three eyes of 22 patients with a mean follow up of 41.4 months were reviewed. Fifteen eyes had failed trabeculectomy and seven had uveitic glaucoma. Mean preoperative IOP reduced from 25.8+/-7.8 to 15.4+/-4.9 mmHg at final visit, a mean change of 41%. Median number of preoperative medications decreased from 3 to 0 postoperatively. Cumulative probability of success was 100% at 2 years, 94% at 3 years and 85% at 4 years. No patient developed any long-term complications. Complete success was achieved in 11 eyes and qualified success in 10 eyes. Two eyes failed and required further surgery. CONCLUSION: NPGS augmented with small-volume MMC/5FU provides good long-term IOP control in eyes at high risk of failure with a lower incidence of complications compared with augmented trabeculectomy and eliminates the need for postoperative bleb or suture manipulation.     

Prognostic risk factors for failure of trabeculectomy with mitomycin C after vitrectomy

Purpose  

To evaluate the prognostic risk factors for failure of trabeculectomy with mitomycin C (MMC) in vitrectomized eyes.     

Five-year results of trabeculectomy with mitomycin C

BACKGROUND: The long-term efficacy and safety of primary trabeculectomy with mitomycin C were retrospectively studied. METHODS: Sixty eyes of 60 patients with severe glaucoma, 25 female and 35 male, with a mean age of 72.5 years who underwent primary trabeculectomy with mitomycin C between 1993 and 1995 were included. Glaucoma subtypes consisted of 42 patients with primary open-angle glaucoma, 10 patients with normal-pressure glaucoma, 2 patients with chronic narrow-angle glaucoma, 5 patients with pigment dispersion syndrome and 1 patient with pseudoexfoliation syndrome. During surgery, mitomycin C 0.2 mg/ml was applied under the scleral flap for 3 min. RESULTS: Mean intraocular pressure (IOP) decreased from 22.3+/-9.3 preoperatively to 12.6+/-3.5 mmHg postoperatively. With success defined as an IOP level of 15 mmHg or less, a success rate of 83.3% was obtained in the 1st year, dropping to 60% in the 6th year following trabeculectomy. Visual fields remained stable in 73.3% of cases during the follow-up period. LogMAR visual acuity increased from 0.2 to 0.4. Four eyes underwent cataract surgery prior to trabeculectomy. Thirteen eyes underwent cataract surgery during the follow-up period. Long-term complications were relatively mild and consisted of two cases of blebitis. Bleb reconstruction was performed in five eyes with overfiltration or bleb-related complaints. CONCLUSIONS: The present findings indicate that the additional use of mitomycin C may be justified in trabeculectomies in patients with severe glaucoma.     

ReGAE 7: long-term outcomes of augmented trabeculectomy with mitomycin C in African Caribbean patients

Background: To evaluate long‐term outcomes and complication rates following trabeculectomy with mitomycin C in a case series of African Caribbean patients. Design: A prospective, observational and non‐comparative case series. Participants: Forty‐seven consecutive African Caribbean patients (47 eyes) with glaucoma. Methods: All patients underwent augmented trabeculectomy with mitomycin C for uncontrolled intraocular pressure (IOP). Survival analysis was performed with a minimum of 12 months' follow up. Main Outcome Measures: Surgical success was based upon IOP reduction to ≤21 mmHg, ≤18 mmHg and ≤15 mmHg without glaucoma medication (complete); or IOP reduction to ≤21 mmHg, ≤18 mmHg and ≤15 mmHg with or without glaucoma medication (qualified). Results: The mean follow‐up period was 48.6 months. At 3 years post‐trabeculectomy 92.6% achieved a qualified success and 59.3% a complete success for an IOP ≤21 mmHg. At final follow up the mean IOP reduced from 33.7 mmHg to 13.1 mmHg (P < 0.0001). Survival rates were 96%, 90% and 86% at 12, 24 and 36 months, respectively, with a mean survival time of 97.4 months (95% confidence interval, 86.0–108.8) for an IOP ≤21 mmHg. Early postoperative hypotony requiring surgical intervention occurred in four (8.5%) patients. There were no cases of blebitis, endophthalmitis, suprachoroidal haemorrhage, malignant glaucoma or hypotony maculopathy. Conclusions: Good long‐term stable IOP can be achieved with low complication rates and high success rates amongst African Caribbean patients following trabeculectomy with mitomycin C. A proactive postoperative management regime is needed to ensure trabeculectomy survival in high‐risk populations.     

Deep sclerectomy augmented with combination of absorbable biosynthetic sodium hyaluronate scleral implant and mitomycin C or with mitomycin C versus trabeculectomy: long-term results

Background: To evaluate the long‐term results following deep sclerectomy with mitomycin C‐SKgel implant (DSMMC‐SKgel), mitomycin C (DSMMC) and trabeculectomy. Design: Comparative case series, Goztepe Training and Educational Hospital. Participants: Ninety‐one open‐angle glaucoma patients. Methods: DSMMC‐SKgel, DSMMC and trabeculectomy operations were performed in 28, 30 and 33 eyes, respectively. Main Outcome Measures: Intraocular pressures (IOP) and distance corrected visual acuities (DCVA) were measured preoperatively and postoperatively at days 1, 7 and months 1, 3, 6, 12, 18, 24, 30, 36, 48. Results: At month 48, deep sclerectomy groups had better DCVAs, and in all groups mean IOPs and number of medications were significantly lower and DCVAs were worse than preoperative values. Mean IOPs in trabeculectomy group at week 1, months 1 and 3 were significantly lower than those in DSMMC group. Mean IOPs in DSMMC‐SKgel group at week 1 and month 1 were significantly lower than those in DSMMC group. Mean preoperative IOPs, postoperative IOPs following 3rd month, complete (IOP ≤ 21 mmHg and ≤18 mmHg without medication) and qualified (IOP ≤ 21 mmHg and ≤18 mmHg with or without medication) success rates of all groups were not statistically different. Rate of complications such as hyphema, hypotony, shallow anterior chamber, bleb leak, bleb fibrosis, cataract, choroidal detachment and macular oedema were found to be significantly higher in trabeculectomy group (P < 0.05). No significant difference in the mean post‐laser goniopuncture IOPs was found between the two deep sclerectomy groups during the follow up. Conclusions: DSMMC, DSMMC‐SKgel and trabeculectomy operations were almost equally effective in lowering IOP at long‐term follow up, but complication rates were higher after trabeculectomy operations.     

小梁切除联合丝裂霉素术后晚期滤泡相关并发症的临床分析

目的：探讨小梁切除联合丝裂霉素术后晚期滤泡相关并发症的发生率及处理。 方法：1994-05／2000．05接受小梁切除手术联合丝裂霉素治疗青光眼65例65眼，采用Kaplan-Meier生存分析法估计晚期滤过泡渗漏、滤泡炎、眼内炎的发生概率。 结果：随访2．5～7．1（平均5．6）a，发生滤过泡渗漏16眼（16／65，24．6％），出现滤泡炎5眼（5／65，7．7％），发生眼内炎1眼，出现复合性滤泡并发症1眼，出现持久性低眼压9眼（9／65，13．8％）。Kaplan-Meier生存分析法估计晚期滤泡并发症5a发生概率为40．0％。多数眼通过门诊处理获得成功，部分眼需手术治疗。 结论：小梁切除联合丝裂霉素术后晚期滤泡相关并发症的发生率可高达40．0％，单纯滤过泡渗漏是一相对良性的状况，只要及时处理，可被修复，滤泡炎或眼内炎可以被控制，而获得正常眼内压。一相对良性的状况，只要及时处理，可被修复，滤泡炎或眼内炎可以被控制，而获得正常眼内压。     

Long term results after low dose ocular irradiation for choroidal haemangiomas

AIM/BACKGROUND—The most common choice of treatment for choroidal haemangiomas (CH) in the past has been the employment of scatter photocoagulation of the surface. This management often requires repetitive treatment or additional invasive management due to massive exudative detachment of the retina. The aim of this retrospective study was to investigate the outcome of the alternative application of low dose external beam irradiation with high energetic photons on these tumours.
METHODS—A total absorbed dose of 20 Gy was applied to a total of 51 symptomatic eyes: 36 with a circumscribed CH of the posterior pole and 15 with diffuse CH as part of the Sturge-Weber syndrome. The indication for treatment was an exudative retinal detachment including or threatening the fovea. The mean follow up times in each group were 4.5 and 5.3 years, respectively. Out of a group of 33 patients from whom reliable data could be derived, 17 had symptoms lasting longer than 6 months.
RESULTS—In 23 cases (63.8%) with circumscribed CH complete resolution of the subretinal fluid was achieved; the remaining 13 cases (36.2%) showed residual serous detachment distant to the fovea. The visual acuity improved by two or more lines in 14 cases (38.9%), remained stable in 14 cases (38.9%), and decreased in eight cases (22.2%). The functional success was dependent on the lag duration between onset of first subjective symptoms and treatment. The morphological results with diffuse CH were similar to those of the group of circumscribed CH. The visual acuity (VA) at last examination was improved in seven cases (46.6%); in the remaining eight cases, VA was unchanged or had deteriorated. The poor functional outcome in the latter was mainly attributable to secondary glaucoma.
CONCLUSION—External beam irradiation is a useful and a low invasive therapeutic option for CH. A successful functional outcome is dependent on the time delay between first onset of symptoms and the beginning of therapy, the formation of subretinal fibrosis, and also on secondary glaucoma in the case of Sturge-Weber syndrome.

     

Factors associated with success in first-time trabeculectomy for patients at low risk of failure with chronic open-angle glaucoma

PURPOSE: To examine the relationships between study factors and trabeculectomy outcome in a representative sample of United Kingdom ophthalmology surgeons and patients. DESIGN: Cross-sectional observational study by questionnaire. PARTICIPANTS: All ophthalmic surgeons performing trabeculectomy in the National Health Service were invited to select their 4 most recent consecutive trabeculectomy cases satisfying study eligibility criteria before June 1996. Three hundred eighty-two surgeons supplied baseline data for 1450 patients and 1-year follow-up data for 1240 (85.3%) patients. All patients had undergone first-time trabeculectomy for chronic open-angle glaucoma. METHODS: Data were collected by self-administered questionnaires at baseline and 6 and 12 months postoperatively. Univariate analysis of the relationships between study factors and success was performed by chi-square test (categorical variables) and Student's t or Mann-Whitney U tests (continuous variables). Multiple logistic regression modeling of explanatory variables significant at a P value of 相似文献   

ReGAE 9: baseline factors for success following augmented trabeculectomy with mitomycin C in African‐Caribbean patients

Background: To identify the baseline factors influencing success following trabeculectomy with mitomycin C in a case series of African‐Caribbean patients. Design: A prospective, observational and non‐comparative cohort study. Participants: Forty‐seven consecutive African‐Caribbean patients (47 eyes) with glaucoma. Methods: Association between trabeculectomy survival and study factors was examined using Fisher's exact test and the Wilcoxon rank sum test at 12, 24 and 36 months following trabeculectomy. Logistic regression was used to establish the combination of factors best predicting survival. Main Outcome Measures: Surgical success was based upon intraocular pressure reduction to ≤21 mmHg, ≤18 mmHg and ≤15 mmHg without glaucoma medication (criterion 1), or intraocular pressure reduction to ≤21 mmHg, ≤18 mmHg and ≤15 mmHg with or without glaucoma medication (criterion 2). Results: Trabeculectomy survival at 36 months was significantly decreased with the use of preoperative acetazolamide, pseudophakic status and higher preoperative intraocular pressure (P < 0.05). In pseudophakic eyes, there was a lower rate of success for criterion 2 when aiming for an intraocular pressure ≤15 mmHg at 2 years post‐trabeculectomy, the odds ratio being 12. Conclusions: Three major independent risk factors were identified that influenced trabeculectomy failure at 3 years in African‐Caribbean ethnicity: the preoperative use of acetazolamide, pseudophakic status and higher preoperative intraocular pressure. The presence of these risk factors may guide the clinician to use a more aggressive antiproliferative and postoperative management regime to enhance survival rates in this high‐risk population.     

Outcomes and risk factors for failure of trabeculectomy with mitomycin C in children with traumatic glaucoma - A retrospective study

Purpose:To determine surgical outcomes and risk factors for failure of trabeculectomy with mitomycin C (TMMC) in pediatric traumatic glaucoma.Methods:Children who underwent TMMC post trauma from January 2014 to December 2019 were reviewed. Demographic features, ocular findings, and surgery details were noted. Surgical success was defined as achieving intraocular pressure (IOP) within 6–21 mm Hg.Results:Seventy-one eyes of seventy patients underwent TMMC. The mean age of the patients was 11.28 ± 3.63 years with a male/female ratio of 13:1. The median time from trauma to IOP rise was 13 days. The majority of the patients (n = 64, 90.1%) had close globe injury. Baseline IOP was 39.3 ± 10.5 mm Hg. Results of the surgery were noted at the last visit. Cumulative success was noted in 51 (71.8%) eyes, while 20 (28.2%) eyes were labeled failures. Mean IOP reduced from 39.3 ± 10.5 to 14.5 ± 8.1 mm Hg. Mean visual acuity improved from 2.3 ± 0.93 to 1.19 ± 1.08 logMAR. Post surgery, the mean follow-up of the patients was 20.3 ± 11.4 months. Age <6 years (RR 3.6), elevated IOP at 1 month after TMMC (RR 2.19), and hypotony within a week of surgery (RR 1.81) were found as independent risk factors of surgical failure.Conclusion:TMMC is effective in reducing IOP in traumatic glaucoma. Young age and inability to control IOP within normal ranges in the immediate period after surgery are important risk factors of failure.     

Long term results of intraoperative mitomycin C in the treatment of recurrent pterygium.

AIM: The study was designed to evaluate the long term results of intraoperative mitomycin C in patients with one recurrence of pterygium. METHODS: In 45 white patients with one recurrence of pterygium the 'bare sclera technique' was performed and a sterile sponge soaked in a 0.2 mg/ml (0.02%) mitomycin C solution was placed intraoperatively on the sclera for 3 minutes. The control group underwent surgical excision only. Recurrences were analysed by the chi 2 test and the method of Kaplan-Meier (life table analysis); the difference between survival curves was tested by the log rank test. The chi 2 test with Yates's correction or Fisher's exact test were used to analyse the difference in complications and side effects between the two groups. RESULTS: After a mean postoperative follow up of 34.55 (SD 13.70) months, 6 recurrences (12.5%) were observed in the mitomycin C treated patients and 16 (35.6%) in the control patients (p = 0.027). The 24 and 48 month life table success rates were 89% and 83% in the mitomycin C treated group and 66% and 63% in the control group, respectively (p = 0.022). No severe side effects appeared during follow up. Superficial punctate keratitis appeared in the early postoperative period in only seven mitomycin C treated eyes (15.5%) (p = 0.018). CONCLUSION: This study confirms the efficacy of intraoperative mitomycin C in improving the success rate after recurrent pterygium surgical excision.     

Clinical experiences and results of application of mitomycin C in trabeculectomy

BACKGROUND: Mitomycin C (MMC) used as an additive agent in glaucoma surgery has been shown to improve the postoperative results of intraocular pressure (IOP), but may also lead to higher incidences of postoperative wound healing disorders and of hypotonia with choroidal detachment. In this retrospective study the levels of IOP, the incidence of complications and changes of the visual acuity (VA) were monitored. METHODS: A trabeculectomy was performed on 70 eyes (57 patients). During surgery MMC was applied in three different concentrations: 0.1 mg/ml MMC (n = 8), 0.2 mg/ml MMC (n = 53) and 0.4 mg/ml MMC (n = 9) for 2.5 minutes, respectively. Patients were reexamined one day, and at 3 and 12 months after surgery. RESULTS: IOP was lowered with high statistical significance at all dates of control examination no matter what concentration of MMC had been used. At the time of discharge from hospital the success rate without additional topical glaucoma medication was 96 %, 78 % after 3 months and 68 % after 12 months. With glaucoma medication the success rate was 92 % after 3 months and 85 % after 12 months. Frequent complications were choroidal detachments in 40 % and hypotonia in 21 % of all cases. The VA did not change significantly during the follow-up period. CONCLUSIONS: This study underlines the efficacy of MMC as an additive agent in glaucoma surgery. However, considerable complications may be expected. Considering the effectiveness and the complication rate a concentration of 0.2 mg/ml MMC should be preferred.     

Surgical results and complications of mitomycin C-augmented trabeculectomy in refractory developmental glaucoma.

BACKGROUND AND OBJECTIVE: To evaluate the surgical results and complications of mitomycin C-augmented trabeculectomy in refractory developmental glaucoma. PATIENTS AND METHODS: The authors reviewed the charts of all patients of refractory developmental glaucoma who underwent mitomycin C-augmented trabeculectomy (0.4 mg/ml for 3 minutes) between September 1990 and August 1995. Thirty-eight eyes of 29 patients were included in the study; 34 eyes (89.5%) had refractory primary congenital glaucoma with documented failure of primary surgery, 2 eyes (5.3%) had Axenfeld-Rieger syndrome and 2 eyes (5.3%) had aniridia. The main outcome measures in this study were preoperative and postoperative intraocular pressures (IOPs),visual acuities, bleb characteristics, success rate, time of surgical failure, and complications. RESULTS: The IOP (mean +/- SD) reduced from a preoperative level of 32.6 +/- 11.8 mm Hg to 12.3 +/- 7.3 mm Hg (P <0.0001) with the percentage reduction in IOP being 56%. Kaplan-Meier survival analysis showed that the success probability at 18 months was 65%, which was maintained till 30 months of follow-up. The bleb was characterized by its large, elevated, avascular, transparent appearance in all the eyes. There were no intraoperative complications. The postoperative complications included hyphema (absorbed one week) in 8 eyes (21%), uncontrolled IOP in 8 eyes (21%), shallow anterior chamber in 3 eyes (7.9%), hypotony without visual loss in one eye (2.6%) and retinal detachment in 2 eyes (5.2%) which was surgically repaired successfully. Visual acuity was maintained in all cases after surgery. None of the patients developed mitomycin-C related late bleb-leakage or endophthalmitis. CONCLUSION: Treatment of refractory developmental glaucoma with mitomycin C-augmented trabeculectomy is effective and safe with an acceptable rate of complications.     

难治青光眼术中使用红比霉素长期疗效观察

目的评价小梁切除联合术中使用红比霉素对难治青光眼的长期疗效.方法对难治性青光眼58例行小梁切除术中,巩膜瓣下放置浸有200μg/m1的红比霉素棉片5分钟.结果术后追综18月,平均眼压2.78±0.49kPa,与术前平均眼压5.20±0.95kPa相比,差别有统计学意义(P＜0.05),不用抗青光眼药物眼压≤2.98kPa占75%.功能滤过泡形成率70.6%,滤口开放率72.4%.无长期严重并发症.结论红比霉素作滤过性手术辅助药物,对难治性青光眼可增加长期的手术成功率,无长期严重并发症.     

Mid-term outcome of trabeculectomy with adjunctive mitomycin C in glaucoma patients

PurposeTo quantify the 2-year success rate and complications of trabeculectomy with adjunctive mitomycin C (MMC).MethodsA retrospective chart review was undertaken of 147 eyes that had undergone trabeculectomy with adjunctive MMC (concentration from 0.1 to 0.27 mg/mL) and at least 2 years' follow-up between January 2001 and March 2010. Demographic and clinical data were collected from all patients at the time of surgery and subsequent follow-up visits. Complete success was defined as intraocular pressure (IOP) ≤ 21 mmHg without any additional medication, whereas qualified success was defined as IOP ≤21 mmHg with or without medication.ResultsAt 24 months, mean IOP was 16.4 ± 10.6 mmHg, with a mean IOP decrease of 19.8 ± 14.2 mmHg. In primary glaucoma patients (n = 66), 60.6% and 95.4% of eyes achieved complete success and qualified success, respectively, at 2-year follow-up. Sub-group analysis of the initial trabeculectomy in primary glaucoma patients (n = 49) showed that complete and qualified success increased to 65.3% and 98.0%, respectively. The success rate was lower in secondary glaucoma patients (n = 74), with complete success at 41.9% and qualified success at 67.6% at 2-year follow-up. Eighty-six eyes (58.5%) developed one or more complications, from mild, such as hyphema, to severe, such as bleb leakage, which could necessitate surgical intervention. Twenty-six eyes developed severe complications, such as wound gap after 5 postoperative days, hypotony, hypotony maculopathy, choroidal detachment, overhanging bleb, bleb leakage, and endophthalmitis. A comparison between eyes with severe complications and other eyes in relation to different MMC amount, defined as MMC concentration multiplied by application duration, revealed no significant difference (p = 0.136). Further glaucoma surgery was performed in 27 eyes (18.4%).ConclusionThe outcome of trabeculectomy with low-dose intraoperative MMC is favorable in primary glaucoma patients at 2-year follow-up. Severe complications are not significantly related to MMC amount. Factors associated with severe complications require further study. Careful selection of MMC concentration and application time based on preoperative and intraoperative risk factors may further improve surgical results.     

Long term visual results of vitrectomy for Eales disease complications

Background and objectives: Complications of Eales disease can cause visual loss. Long term visual prognosis following vitrectomy for Eales disease complications has been studied. Patients and methods: Retrospective analysis of 64 eyes of 57 patients who underwent vitrectomy for Eales disease complications with a minimum follow-up of 60 months. Results: 62.4% eyes at 2 months and 71.8% at 60 months had 6/60 or better visual acuity. Visual acuities for individual cases were quite stable at the 60 month follow up with 50 eyes (78.5%) either maintaining or improving upon their 2 month post operative visual acuity. Conclusion: Visual acuity improves after vitrectomy in majority of patients with Eales disease complications and remains stable on long term follow-up.