Mitomycin C-augumented trabeculectomy with postoperative wound modulation in pediatric glaucoma

Purpose: The purpose of this study was to evaluate mitomycin C-augmented tr abeculectomy combined with postoperative subconjunctival 5-fluorouracil and laser suture lysis in the treatment of refractory pediatric glaucoma. Meth ods: Twenty-one consecutive cases(17 patients) with refractory pediatric gl aucoma treated with mitomycin C trabeculectomy (0.4 mg/mL for 3 to 5 minute s) and postoperative 5-fluorouracil, laser suture lysis, or both were retro spectively reviewed. Success was defined as intraocular pressure between 4 and 16; mm Hg without further glaucoma surgery or devastating complication. Results: The median age of the study population was 2.6 years (range, 0.05 to 16 years). The overall success rate was 52.4%, with a median follow-up of 23 months for successful cases. Success rates for patients older than 1 year of age versus those younger than 1 year of age at surgery were 73% and 30%, respectively. Success rates for phakic versus aphakic eyes were 64% a nd 29%, respectively. Age and lens status, taken together, were significant predictors of outcome (P=.013). Reasons for failure in this study were unc ontrolled intraocular pressure (8 cases), persistent wound leak (1 case), a nd endophthalmitis (1 case); the latter 2 cases required bleb excision. Oth er complications encountered included chorioretinal detachment, shallow ant erior chamber, 5-fluorouracil toxicity, and cataract formation. No irrevers ible visual deficits could be attributed to the trabeculectomy procedure or subsequent complications in any of these cases. Conclusions: Mitomycin C-a ugmented trabeculectomy combined with postoperative suture lysis and 5-fluo rouracil is a viable option for older phakic children with refractory glauc oma. This procedure has a lower success rate in infants and in aphakic eyes . Both early and late postoperative complications are common, and diligent lifelong long-term follow-up is needed to detect bleb leaks and infection. The addition of postoperative suture lysis and 5-fluorouracil to mitomycin C-augmented trabeculectomy did not provide any convincing improvement in th e success of this procedure in pediatric patients with refractory glaucoma and may have increased the complication rate.