Nine-year follow-up of trabeculectomy with or without low-dosage mitomycin-c in primary open-angle glaucoma.

Abstract

To evaluate the long-term efficacy and safety of trabeculectomy with or without low-dosage Mitomycin-C (MMC) in primary open-angle glaucoma (POAG). 114 patients affected by POAG, participating in a randomised clinical trial from 1995 to 1998, were re-examined and their chart reviewed. Patients had undergone in one eye a trabeculectomy with intraoperative application (2 min) of MMC (0.2 mg/ml) or balanced saline solution (BSS), and, if indicated, postoperative laser suture lysis, bleb needling and/or digital massage. Intraocular pressure (IOP), medical therapy, visual field, further glaucoma surgery, cataract surgery and complication rate (leakage, cataract progression, hypotony, blebitis, endophthalmitis) were evaluated. 67 eyes had received MMC and 47 BSS. MMC-treated eyes had a lower mean IOP (13.33+/-3.35 vs 14.72+/-2.19 mm Hg, p = 0.014); in this group, an higher percentage of eyes had IOP < or = 18 mm Hg (73.1% vs 51.1%, p = 0.027) and IOP < or = 14 mm Hg (56.7% vs 31.9%, p = 0.015); a lower rate had further glaucoma surgery (9% vs 25.5%, p = 0.040), and visual-field damage progression (21.1% vs 48.6%, p = 0.009). No difference was seen in the complication rate: one MMC-treated eye developed blebitis. In POAG low-dose MMC with intensified postoperative management improved the outcome of the trabeculectomy with a low incidence of complications.