Initial trabeculectomy with intraoperative mitomycin-C application in primary glaucomas

PURPOSE: This is a prospective randomized study designed to compare the overall efficacy of intraoperative application of mitomycin-C (MMC) in eyes with no previous ocular surgery versus standard trabeculectomy without MMC. METHODS: Twenty-five patients with primary glaucoma had been treated with trabeculectomy in one eye and trabeculectomy with MMC in the other eye. Patients were followed up for 18 months. RESULTS: Intraocular pressure (IOP) was 20 mm Hg or less in 23 eyes (92%) in the treatment group after a mean follow up of 17.8 +/- 1.1 months and 17 control eyes (68%) after mean follow up period of 17.8 +/- 1.2 months (range, 16.7-19 months). Wound leaks occurred in 10 (40%) of the treatment group and 3 (12%) of control group. Bleb scarring developed in 1 eye (4%) of the treatment group and 6 (24%) of the control group. Hypotony maculopathy developed in 3 (12%) of the MMC group. Postoperatively, laser suture lysis was needed in 13 (52%) of the treatment group and 21 (84%) of the control group. Additional filter was needed in (4%) of the treatment group, while additional filters were needed in 7 (28%) of the control group. CONCLUSION: Intraoperative MMC application may increase the success rate of glaucoma surgery, but close follow-up and meticulous management of patients are needed, especially in the early postoperative period.