The increasingly iatrogenic indications for mitomycin C trabeculectomy over 10 years.

The increasingly iatrogenic indications for mitomycin C trabeculectomy over 10 years. Macdonald E, Mukherjee S, Jay J. Objective: The success of trabeculectomy can be adversely affected by certain risk factors. In these cases, the outcome can be improved by the intraoperative use of mitomycin C (MMC). We aimed to investigate the impression that this operation was being performed more often in our unit and that the risk factors were changing.Design: Retrospective review.Participants: The study involved 107 MMC trabeculectomies during the 2 separate study periods.Methods: Operating theatre logbooks were used to identify patients who had undergone MMC trabeculectomy during 2 separate periods of 32 months, 10 years apart. Patient characteristics, the indication for surgery (previously failed trabeculectomy; aphakic/pseudophakic glaucoma; uveitic, developmental, or rubeotic glaucoma; post-vitreoretinal (VR) surgery glaucoma; postkeratoplasty glaucoma; and other), and follow-up data regarding intraocular pressure control were recorded.Results: In the later period, 71 MMC trabeculectomies were performed, compared with 36 in the earlier period, a significant rise (p ? 0.05). The most obvious change in indication was an increase for postkeratoplasty and post-VR surgery glaucoma, which accounted for 77.1% of the additional operations. Intraocular pressure control at 1 year following surgery was good, particularly in the later period, with 88.8% controlled with the addition of topical medication where necessary. Complications in both periods were rare.Conclusions: The frequency of MMC trabeculectomies has doubled over a 10-year period in our unit. Postkeratoplasty and post-VR surgery glaucomas are increasingly contributing to the caseload of complex glaucoma in our hospital. These cases may be managed effectively with MMC trabeculectomy. Can J Ophthalmol. 2009 Apr;44(2):205-8. PMID: 19491957 [PubMed - in process]