Surgical results and complications of mitomycin C-augmented trabeculectomyin refractory developmental glaucoma

BACKGROUND AND OBJECTIVE: To evaluate the surgical results and complication s of mitomycin C-augmented trabeculectomy in refractory developmental glauc oma. PATIENTS AND METHODS: The authors reviewed the charts of all patients of re fractory developmental glaucoma who underwent mitomycin C-augmented trabecu lectomy (0.4 mg/ml for 3 minutes) between September 1990 and August 1995. T hirty-eight eyes of 29 patients were included in the study; 34 eyes (89.5%) had refractory primary congenital glaucoma with documented failure of prim ary surgery, 2 eyes (5.3%) had Axenfeld-Rieger syndrome and 2 eyes (5.3%) h ad aniridia. The main outcome measures in this study were preoperative and postoperative intraocular pressures (IOPs),visual acuities, bleb characteri stics, success rate, time of surgical failure, and complications. RESULTS: The IOP (mean +/- SD) reduced from a preoperative level of 32.6 +/ - 11.8 mm Hg to 12.3 +/- 7.3 mm Hg (P < 0.0001) with the percentage reducti on in IOP being 56%. Kaplan-Meier survival analysis showed that the success probability at 18 months was 65%, which was maintained till 30 months of f ollowup. The bleb was characterized by its large, elevated, avascular, tran sparent appearance in all the eyes. There were no intraoperative complicati ons. The postoperative complications included hyphema (absorbed one week) i n 8 eyes (21%), uncontrolled IOP in 8 eyes (21"/o), shallow anterior chambe r in 3 eyes (7.9%), hypotony without visual loss in one eye (2.6%) and reti nal detachment in 2 eyes (5.2%) which was surgically repaired successfully. Visual acuity was maintained in all cases after surgery. None of the patie nts developed mitomycin-C related late bleb-leakage or endophthalmitis. CONCLUSION: Treatment of refractory developmental glaucoma with mitomycin C -augmented trabeculectomy is effective and safe with an acceptable rate of complications.