MITOMYCIN C-AUGMENTED TRABECULECTOMY IN REFRACTORY CONGENITAL GLAUCOMA

Objective: The purpose of the study is to determine the safety and eff icacy of mitomycin C-augmented trabeculectomy in children with develop mental glaucoma treated previously by conventional procedures. Design: Retrospective review of all cases of developmental glaucoma with prev iously failed conventional procedures that underwent mitomycin C-augme nted trabeculectomy between January 1992 and December 1994. Participan ts: A total of 19 eyes of 13 patients were included in the study. Nine teen eyes included primary congenital glaucoma (15 eyes) with document ed failure of primary trabeculotomy, Axenfeld-Reiger syndrome (2 eyes) and aniridia (2 eyes). Intervention: Mitomycin C-augmented (0.4 mg/ml for 3 minutes) trabeculectomy was the chosen intervention. Main outco me measures: Preoperative and postoperative intraocular pressures (IOP s), visual acuities, success rate, bleb characteristics, time of surgi cal failure, and complications were the main outcome measures. Results : The mean IOP was reduced from a preoperative level of 33.74 +/- 10.7 0 mmHg to 11.89 +/- 1.33 mmHg (P < 0.0001) with the percentage reducti on in IOP being 64.75. The mean follow-up was 19.52 +/- 2.65 months. V isual acuity was maintained in all the cases after surgery. Complete s uccess as defined in the authors' study was achieved in 18 eyes (94.74 %). Only one patient was classified as a qualified success. The bleb w as characterized by its large elevated, avascular, transparent appeara nce in all the eyes. The only significant complication was retinal det achment in an eye with buphthalmos, aphakia, and large axial length. H owever, the retina was reattached successfully by retinal reattachment surgery, and visual acuity improved to the preoperative level of 20/2 00. It was not possible to determine the cause of retinal detachment o r to assess the possible role of mitomycin C in this complication. Con clusions: Mitomycin C-augmented trabeculectomy is a viable option in e yes with failed conventional trabeculotomy surgery.