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

Publication ,  Journal Article
Freedman, SF; McCormick, K; Cox, TA
Published in: J AAPOS
April 1999

PURPOSE: The purpose of this study was to evaluate mitomycin C-augmented trabeculectomy combined with postoperative subconjunctival 5-fluorouracil and laser suture lysis in the treatment of refractory pediatric glaucoma. METHODS: Twenty-one consecutive cases (17 patients) with refractory pediatric glaucoma treated with mitomycin C trabeculectomy (0.4 mg/mL for 3 to 5 minutes) and postoperative 5-fluorouracil, laser suture lysis, or both were retrospectively 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% and 29%, respectively. Age and lens status, taken together, were significant predictors of outcome (P = .013). Reasons for failure in this study were uncontrolled intraocular pressure (8 cases), persistent wound leak (1 case), and endophthalmitis (1 case); the latter 2 cases required bleb excision. Other complications encountered included chorioretinal detachment, shallow anterior chamber, 5-fluorouracil toxicity, and cataract formation. No irreversible visual deficits could be attributed to the trabeculectomy procedure or subsequent complications in any of these cases. CONCLUSIONS: Mitomycin C-augmented trabeculectomy combined with postoperative suture lysis and 5-fluorouracil is a viable option for older phakic children with refractory glaucoma. 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 the success of this procedure in pediatric patients with refractory glaucoma and may have increased the complication rate.

Duke Scholars

Published In

J AAPOS

DOI

ISSN

1091-8531

Publication Date

April 1999

Volume

3

Issue

2

Start / End Page

117 / 124

Location

United States

Related Subject Headings

  • Wound Healing
  • Treatment Outcome
  • Trabeculectomy
  • Retrospective Studies
  • Ophthalmology & Optometry
  • Ophthalmic Solutions
  • Mitomycin
  • Male
  • Laser Therapy
  • Intraocular Pressure
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Freedman, S. F., McCormick, K., & Cox, T. A. (1999). Mitomycin C-augumented trabeculectomy with postoperative wound modulation in pediatric glaucoma. J AAPOS, 3(2), 117–124. https://doi.org/10.1016/s1091-8531(99)70082-0
Freedman, S. F., K. McCormick, and T. A. Cox. “Mitomycin C-augumented trabeculectomy with postoperative wound modulation in pediatric glaucoma.J AAPOS 3, no. 2 (April 1999): 117–24. https://doi.org/10.1016/s1091-8531(99)70082-0.
Freedman SF, McCormick K, Cox TA. Mitomycin C-augumented trabeculectomy with postoperative wound modulation in pediatric glaucoma. J AAPOS. 1999 Apr;3(2):117–24.
Freedman, S. F., et al. “Mitomycin C-augumented trabeculectomy with postoperative wound modulation in pediatric glaucoma.J AAPOS, vol. 3, no. 2, Apr. 1999, pp. 117–24. Pubmed, doi:10.1016/s1091-8531(99)70082-0.
Freedman SF, McCormick K, Cox TA. Mitomycin C-augumented trabeculectomy with postoperative wound modulation in pediatric glaucoma. J AAPOS. 1999 Apr;3(2):117–124.
Journal cover image

Published In

J AAPOS

DOI

ISSN

1091-8531

Publication Date

April 1999

Volume

3

Issue

2

Start / End Page

117 / 124

Location

United States

Related Subject Headings

  • Wound Healing
  • Treatment Outcome
  • Trabeculectomy
  • Retrospective Studies
  • Ophthalmology & Optometry
  • Ophthalmic Solutions
  • Mitomycin
  • Male
  • Laser Therapy
  • Intraocular Pressure