To evaluate the long-term efficacy and safety of trabeculectomy with adjunctive intraoperative use of mitomycin C (MMC) in paediatric patients with primary and secondary glaucomas, and to identify risk factors for failure of this technique. A retrospective, noncomparative study of consecutive paediatric patients with glaucoma that underwent mitomycin C-augmented trabeculectomy from January 1995 to December 2005. The medical records of 61 consecutive patients (78 eyes) with a mean age of 7.3 years (range: 5 months to 17.3 years) were reviewed. A variety of primary and secondary glaucomas were identified. Mitomycin C (0.5 mg/ ml) on a surgical sponge was applied to the episcleral surface for an average of 3.6 ± 1.2 minutes (range: 2–5 minutes). Patients were followed up until a repeat glaucoma surgery after a minimum of 12 months. The clinical outcome examination included intraocular pressure (IOP) control, visual acuity, complications, and risk factors for failure. The surgical outcome was evaluated using Kaplan- Meier life-table analysis. Success was defined as IOP control of 22 mmHg or less with or without topical antiglaucoma medications, no evidence of glaucoma progression, without further glaucoma surgery, and without visually devastating complications. The outcomes for the group of patients with primary infantile glaucoma were compared with those for the group with secondary glaucoma. The mean follow-up was 6.2 ± 4.8 years (range: 1.2 to 11.5 years). The mean preoperative IOP for all eyes was 35.4 ± 9.7 mmHg (range: 24 to 55 mmHg) and the postoperative mean IOP in all eyes was 19.3 ± 11.7 mmHg (range: 5 to 43 mmHg) (p<0.05). The 12-, 24-, 36-, 48- and 60-month life-table cumulative probabilities of the success rate for IOP control were 79 %,71 %, 65 %, 62 % and 58 %, respectively. Multivariate regression analysis determined the following factors as a significantly increased risk for failure: age of less than 1 year at time of surgery, aphakia, aniridia, anterior segment dysgenesis, and gipsy race. There was no difference in the cumulative success rate (p= 0.114) during follow-up between primary (n=35 eyes) and secondary glaucoma (n=43 eyes) patients. A total of 28 eyes (35.9 %) were classified as failures: 25 eyes failed due to elevated intraocular pressure and the need for subsequent glaucoma surgery, 3 eyes failed due to a suprachoroidal haemorrhage, retinal detachment and loss of light perception. Six eyes (7.6 %) experienced a late bleb-related infection at 2 to 5 years after surgery. Other complications included flat anterior chamber, hyphaema, chronic hypotonia, serous choroidal detachment, spontaneously resolved. Our study demonstrates that trabeculectomy with intraoperative adjunctive mitomycin C is an effective treatment for many paediatric glaucomas in which goniotomy, trabeculotomy or both have failed. Bleb–related endophthalmitis is an important risk of this surgery in children. Phakic children over 1 year of age at the time of surgery have a significantly higher probability of success than aphakic eyes in younger children.

Department of Paediatric Ophthalmology Faculty of Medicine Masaryk University Hospital Brno

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