Trabeculectomy with mitomycin-C in the treatment of pediatric glaucomas

Purpose: To evaluate the effectiveness and safety of trabeculectomy with mi tomycin-C (MMC) in the management of childhood glaucomas. Design: Retrospective, noncomparative case series. Participants: All patients less than 18 years of age who underwent trabecul ectomy with MMC from June 1991 through October 1997 were included. Methods: The medical records of 29 consecutive patients (29 eyes) were revi ewed. Data collected during routine patient follow-up were analyzed. Surgic al outcome was evaluated using Kaplan-Meier life-table analysis. Main Outcome Measures: Clinical outcome assessment included intraocular pre ssure (IOP) control, visual acuity, and identification of complications. Su ccessful IOP control was defined as 5 mmHg less than or equal to final IOP less than or equal to 21 mmHg, with or without antiglaucoma medications and without further glaucoma surgery or loss of light perception. Outcomes for the group of patients with primary infantile glaucoma were compared with t hose for the group with secondary glaucomas. Results: Mean patient age was 6.4 +/- 4.4 years (range, 0.2-15.3 years). A variety of primary and secondary glaucomas were represented. Mitomycin-C (0 .5 mg/ml) on a surgical sponge was applied to the episcleral surface for an average of 3.8 +/- 1.0 minutes (range, 1.5-5.0 minutes). Mean follow-up ti me for patients categorized as successes was 25.1 +/- 16.0 months (range, 5 .5-59.7 months). The 12-, 24-, and 36-month life-table success rates for IO P control were 82%, 59%, and 59% respectively. There was no difference betw een the primary infantile glaucoma group and the secondary glaucoma group w ith respect to length of follow-up, rate of successful IOP control, and inc idence of complications. Five patients (17%) experienced late bleb-related infection (BRI) at an average of 27.9 +/- 18.1 months (range, 5.4-55.5 mont hs) after surgery. Other complications included hyphema, retinal detachment , late-onset bleb leak, flat anterior chamber, chronic hypotony, decompress ion retinopathy, suture abscess, and phthisis. Conclusions: Trabeculectomy with MMC may be useful in the management of chi ldhood glaucomas in which goniotomy, trabeculotomy, or both have failed. Ho wever, the high incidence of BRI in this series over an extended follow-up interval dictates caution in using MMC as an adjunct in pediatric trabecule ctomy. (C) 2000 by the American Academy of Ophthalmology.