RESULTS OF TRABECULECTOMY WITH 0.3 MG ML MITOMYCIN-C TITRATING EXPOSURE TIMES BASED ON RISK-FACTORS FOR FAILURE/

Purpose: To examine the efficacy of trabeculectomy with mitomycin C 0. 3 mg/ml using titrated exposure times. Methods: A retrospective chart review of consecutive patients undergoing trabeculectomy in an academi c referral glaucoma clinic was performed. All patients received trabec ulectomies performed by one surgeon (M.B.S.). The study included 57 ey es of 57 patients using mitomycin C with exposure times titrated from one to five minutes based on risk factors for trabeculectomy failure. Surgical success was defined as a final intraocular pressure (IOP) of less than 21 mmHg with or without medications or a 25% reduction in IO P if preoperative IOP was 21 mmHg or less. Patients requiring repeat t rabeculectomies were considered failures regardless of their final IOP . Patients receiving different mitomycin C exposure times were compare d but statistical analysis was not used because these subgroups were n ot randomized. Results: An overall surgical success rate of 84.2% was achieved at a mean followup of 11.9 months. The surgical success rate and percentage IOP reduction was similar between exposure time subgrou ps. Hypotonous maculopathy was observed in three patients (5.3%). All cases of hypotonous maculopathy occurred in the lower-risk patients re ceiving one to three minute exposure times to mitomycin C. Conclusions : We believe mitomycin C should be used sparingly if at all in patient s at lower risk for trabeculectomy failure. This concentration of mito mycin C with four to five minute exposure times appears to be efficaci ous for patients with multiple risk factors for trabeculectomy failure .