Adjunctive mitomycin C in primary trabeculectomy in young adults: a long-term study of case-matched young patients

Objective: The purpose of this study was to determine the efficacy of initial mitomycin C (MMC)-augmented trabeculectomy for uncomplicated glaucoma in young patients. Methods: A retrospective chart review was performed on all glaucoma patients aged between 15 and 40 years without previous surgery that underwent initial trabeculectomy with MMC between 1988 and 1995 at the University Eye Hospital of Cologne. Success (survival) was defined as an intraocular pressure (IOP) of 21 mmHg or lower, with (qualified success) or without (complete success) glaucoma medications. The results were compared with a case-matched control group that did not receive antiproliferative therapy. Results: Eleven eyes of 11 patients fulfilled the inclusion criteria of initial MMC-augmented trabeculectomy. Using cumulative life-table analysis the success rate was 91% at 1 year and 73% at 5 years for the control group. For the MMC group the success rate was 91% at I year and 5 years, respectively. At final visit, mean TOP was significantly (P<0.001) lower for the MMC group (13.3+/-3.9 mmHg) than for controls (18.0+/-1.3 mmHg). Significant differences were also found in the complication rate: complications associated with excessive aqueous overfiltration, such as shallow anterior chamber (36%), choroidal detachment (45%) and persistent hypotony (27%), featured particularly in the MMC group. Conversely, scarring of the filtering bleb (18%) and Tenon's cysts (18%) were observed exclusively in control eyes. Conclusion: The present results suggest that initial MMC trabeculectomy for uncomplicated glaucoma in young patients significantly reduces IOP and number of adjunctive medications, postoperatively, albeit at the price of a high incidence of hypotony.