SURGICAL REVISION OF HYPOTONY FOLLOWING G LAUCOMA SURGERY WITH MITOMYCIN-C

Purpose: Persistent hypotony with maculopathy is a severe complication of mitomycin C when used during filtration surgery. We wanted to know whether this complication can be controlled by a surgical reintervent ion yielding tight closure of the initial sclerostomy. Method: In our clinic, 52 eyes underwent filtering surgery with intraoperative applic ation of mitomycin C, Seven of them required a reoperation owing to pe rsistent hypotony with maculopathy. During this reoperation, the scler al flap was tightly sutured (5x) or, ii necessary, was closed with deh ydrated human dura mater (2x). Results: In all cases the intraocular p ressure increased immediately (i. e., within less than 24 h) after reo peration. This intraocular pressure increase was accompanied by a simu ltaneous regression of the maculopathy. Further details: mean intraocu lar pressure (mmHg): before initial operation with mitomycin C: 38.5+/ -2.9; after initial operation: 3.7+/-0.6; before reoperation (= 8 mont hs after initial operation): 3.3+/-0.7; 24 h after reoperation: 22.0+/ -2.9; 9 months after reopertion: 16.7+/-1.7. Mean visual acuity: befor e initial operation with mitomycin C: 0.72+/-0.1; after initial operat ion: 0.34+/-0.1; before reoperation (= 8 months after initial operatio n); 0.17+/-0.05; 24 h after reoperation: 0.28+/-0.05; 9 months after r eoperation: 0.55+/-0.1. Conclusions: (1) Since the interval between re operation and intraocular pressure increase was very short in all case s, overfiltration is at least one major reason for hypotony, not only ciliary body failure; (2) in cases of persistent hypotony after filter ing surgery with mitomycin C, surgical reintervation can be recommende d. During this reoperation, the initial sclerostomy should be closed t ightly.