Mirza Shafiq Ali Baig, Jamshed Ahmed, Mir Amjad Ali.
Trabeculectomy with Mitomycin-C.
Pak J Surg Jan ;24(1):49-52.

Objective: To study the efficacy and safety of trabeculectomy augmented with intra-operative application of Mitomycin- C (MMC) in various types of refractory glaucomas. Design & Duration: Quasi experimental study from Jan. 2002 to Dec. 2007. Setting: Department of Ophthalmology, Unit-I, Civil Hospital and Dow University of Health Sciences, Karachi. Patients: Forty patients with a number of refractory glaucomas who underwent trabeculectomies with MMC. Methodology: MMC 0.02% (0.2mg/ml) was applied to 52 eyes of 40 patients being operated for trabeculectomies under the partial thickness scleral flap with an exposure time of three minutes. Visual outcome, control of intraocular pressure (IOP) and complications were evaluated. Results: There were 25 males and 15 females in the study with an average age of 41.3(range 1-65) years and an average follow up of 26.4 months (range 12-60 months). The average preoperative IOP was 32.5mm Hg (range 24- 52 mmHg) on an average of 1.34 medications, and the mean postoperative IOP after one year in successful cases was 14.42mmHg (range 12-18 mm Hg) without any medication (qualified success) in 45(86.5%) cases; five patients required one medication. Early postoperative complications included hypotony of more than one month duration in 11(21.2%) cases, hyphema of more than one week duration in 7(13.5%) and epithelial defect in 3(5.76%) cases. Late complication included cataract in 21(40.4%) cases, uncontrolled intraocular pressure despite medical therapy in two (3.84%) cases who further underwent Ahmed glaucoma valve implantation. One case (1.92%) of hypotonous maculopathy was noted. Conclusions: Trabeculectomy with MMC is a promising, safe and effective modality in the management of refractory glaucomas. As the complications related to bleb thinning increases with time, hence further study is required to determine the long term complications.

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