Trabeculectomy with large area mitomycin-C application as a first-line treatment in advanced glaucoma: Retrospective review

AIM To evaluate the outcomes of trabeculectomy with large area mitomy cin-C (MMC) application as a first line treatment in advanced glaucoma. METHODS The records of 55 patients with severe visual field defects undergoing trabeculectomy were retrospectively reviewed. The patients were classified as first-line therapy to either early trabeculectomy (initial trabeculectomy-Group 1) or long term medical therapy followed by trabeculectomy (primary trabeculectomy-Group 2). Trabeculectomy was performed with large-area MMC application. Intraocular pressure (IOP) values, visual acuities, mean deviations, morphology and function of the blebs, necessity for anti-glaucomatous medications and surgical complications were reported. RESULTS There were 20 eyes of 18 patients in Group 1 and 37 eyes of 37 patients in Group 2. The mean preoperative IOPs in Groups 1 and 2 were 40.2 ± 10.0 mm Hg (27-68 mm Hg) and 29.0 ± 4.4 mm Hg (21-41 mm Hg), respectively (P=0.001). Average preoperative mean deviations (MD) in Groups 1 and 2 were 17.4 ± 2.8dB (13.3 -23dB) and 17.9 ± 2.4 dB (13.7-23.2dB), respectively (P=0.441). Postoperative IOPs significantly decreased and were comparable in both Groups. The mean number of medications was significantly higher in Group 2 (P=0.005). No cystic bleb formation was observed in Group 1, whereas 4 patients from Group 2 (10.8%) developed cystic bleb (P=0.040). No visually devastating com plication has occurred in both Groups. CONCLUSION Initial trabeculectomy with large area MMC application might be applied in patients with advanced glaucoma with low complication rates. Long-term topically applied anti-glaucomatous medications seem to increase the risk of cystic bleb formation.