COMPARISON OF MITOMYCIN-C TRABECULECTOMY, GLAUCOMA DRAINAGE DEVICE IMPLANTATION, AND LASER NEODYMIUM, YAG CYCLOPHOTOCOAGULATION IN THE MANAGEMENT OF INTRACTABLE GLAUCOMA AFTER PENETRATING KERATOPLASTY

Purpose: This study aimed to compare the surgical outcomes of mitomyci n C trabeculectomy glaucoma drainage device (GDD) surgery and laser ne odymium:YAG (Nd:YAG) cyclophotocoagulation (CPC) in the management of intractable glaucoma after penetrating keratoplasty (PKP) in a retrosp ective study. Design: Interventional case series. Participants/Methods : The medical charts of consecutive patients who had pre-existing glau coma or who developed glaucoma after PKP and underwent a surgical proc edure to control the glaucoma at the University Eye Associates of Bost on University Medical Center, New England Eye Center, and Massachusett s Eye and Ear Infirmary between January 1991 and July 1995 were review ed. Follow-up ranged from 6 months to 4 years after the glaucoma proce dure. A total of 38 patients were included consisting of 17 patients w ho underwent mitomycin C, 10 patients who underwent GDD surgery, and 1 1 patients who had CPC. Intervention: Mitomycin C trabeculectomy, GDDs , or Nd:YAG CPC to control glaucoma after PKP was performed. Main Outc ome Measures: Graft status, postoperative intraocular pressure (IOP), and visual acuity were the main outcome measures. Results: There were no differences among the three groups with respect to the follow-up ti me after the corneal graft operation (P = 0.15) or after the glaucoma operation (P = 0.98). At the final follow-up, the average decrease in the IOP was 17 mmHg (P < 0.001) after mitomycin C, 15 mmHg (P = 0.003) after GDD surgery, and 14.4 mmHg (P = 0.001) after CPC. There were no differences in the proportion of patients who developed postoperative IOP above 20 mmHg (P = 0.50) and in the proportion who developed hypo tony (P = 0.10) among the three groups. Two grafts failed after mitomy cin C and one failed after CPC. Among the three procedures, there were no differences in the proportion of patients who experienced either a n improvement (P = 0.14) or a decrease (P = 0.22) in the visual acuity by more than one line after the glaucoma procedure. One patient each in the GDD group and the CPC group lost light perception after the pro cedure. The risk of graft failure was almost three times higher for ea ch additional PKP (odds ratio = 2.80, P = 0.02). Conclusions: No diffe rences were found among the three glaucoma procedures with respect to controlling IOP and graft failure. There was a trend for patients trea ted with CPC to have a higher incidence of graft failure, glaucoma fai lure, hypotony, and visual loss by more than one line, although this w as not statistically significant. The number of PKPs was associated wi th graft failure, independent of the surgical procedure.