TRABECULECTOMY WITH ADJUNCTIVE MITOMYCIN-C IN PEDIATRIC GLAUCOMA

PURPOSE: To determine the safety and efficacy of trabeculectomy with a djunctive mitomycin C in patients 17 years of age or younger, and to i dentify risk factors for failure of this surgical technique. METHODS: Retrospective review of consecutive cases of pediatric glaucoma that u nderwent mitomycin C augmented trabeculectomy between January 1991 and December 1995, Forty-nine patients (60 eyes) with a mean age of: 7.6 years (range, 6 weeks to 17,6 years) were identified and followed up u ntil repeal: glaucoma surgery, or after a minimum of 6 months. Success was de fined as intraocular pressure control of 22 mm Hg or less with or without topical glaucoma control medication, no evidence of glauco ma progression, no further glaucoma surgery necessary, and no visually devastating complication, RESULTS: Cumulative probabilities of succes s +/- SD for 49 eyes tone eye per patient) were 67% +/- 13% at 12 mont hs and 59% +/- 15% at 24 months. Multivariate regression analysis yiel ded the following characteristics as significantly increased risk for failure: age of less than 1 year at time of: surgery (risk ratio, 5.6; confidence interval, 2.1 to 14.7; P =.0005), and aphakia (risk ratio, 2.7; confidence interval, 1.1 to 6.9; P = .0364), Shallow anterior ch amber (17 [28%] of 60 eyes) and serous choroidal detachment (13 [22%] of 60 eyes) were the most common complications. Four (11%) of 38 eyes with obtainable Snellen acuity were noted to have a decrease in best-c orrected visual acuity of more than 2 Snellen lines or loss of light p erception. In 5 (8%) of 60 eyes bleb-related endophthalmitis was noted . CONCLUSIONS: Trabeculectomy with adjunctive mitomycin C is generally effective for the treatment of pediatric glaucoma, especially in phak ic children over 1 year of age. However, late-onset bleb-related endop hthalmitis is a substantial risk in this patient population. (Am J Oph thalmol 1998;126:648-657, (C) 1998 by Elsevier Science Inc. All rights reserved.).