Efficacy and safety of mitomycin C--augmented revisions of non-functioning filtering blebs after trabeculectomy--7 year results.

PURPOSE

To determine the efficacy and safety of mitomycin C-augmented revision in eyes after failed primary trabeculectomy failure.

MATERIAL AND METHODS

Retrospective review of 40 eyes after a single MMC-augmented revision due to primary trabeculectomy failure.

MAIN OUTCOME MEASURES

intraocular pressure, best corrected visual acuity, number of antiglaucoma medications, complications.

RESULTS

Twelve months after revision the mean intraocular pressure declined from 24.5 +/- 6.7 mmHg to 15.4 +/- 4.4 mmHg (p < 0.05) and remained decreased at 24 months (16.33 +/- 4.2 mmHg) and at 84 months (16.75 +/- 2.8 mmHg). The therapeutic success, defined as intraocular pressure < or = 18 mmHg without medication at 12 months after revision, was achieved in seventeen eyes (42.5%). Fourteen eyes (35.0%) achieved qualified success, defined as intraocular pressure < or = 18 mmHg with antiglaucoma medication, and 9 of 40 eyes (22.5%) were classified as failures. Mean best corrected visual acuity did not change significantly after the surgery (12 month: p = 0.76, 36-48 months: p = 0.25, 72-84 months: p = 0.15). The mean number of medications was reduced from 1.2 +/- 0.8 preoperatively to 0.68 +/- 0.8 postoperatively at 12 months, to 0.78 +/- 0.49 at 24 months and the drop was statistically significantly. Early complications developed in 7 (17.5%) eyes but they resolved spontaneously.

CONCLUSIONS

MMC-augmented revision appears to be a safe and useful tool in reducing intraocular pressure after trabeculectomy failure. This simple-technique procedure is successful in 42.5% of eyes for up to 24-36 months and helps protect the eye from other surgical intervention, more destructive for the conjunctiva.