Cumulative effect of risk factors on short-term surgical success of mitomycin augmented trabeculectomy

H. C. Agarwal, T. K. Sharma, R. Sihota, V. Gulati

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Context: Risk factors for failure of trabeculectomy may have a cumulative effect on the outcome. Aims: To study the effect of preoperative ocular risk factors on the surgical outcome of trabeculectomy augmented with 2 commonly used doses of Mitomycin C. Settings and Design: In a prospective cohort study, cases were recruited over an 18 month period. 92 eyes of 83 patients with one to three known risk factors for failure of trabeculectomy underwent Mitomycin-C (MMC) augmented trabeculectomy. Methods and Material: Trabeculectomy was done with a randomly chosen MMC dose of 0.2 mg/ml or 0.4 mg/ml. All cases were followed up for a period of at least 3 months. Surgical success was defined as the lowering of intraocular pressure (IOP) below 21 mmHg during the follow up period. Statistical Analysis Used: Chi square test, paired t test, odds ratio, effect size. Results: Eyes with two or three risk factors (out of aphakic glaucoma, failed trabeculectomy, neovascular glaucoma, post uveitic glaucoma, traumatic glaucoma, adherent leucoma, juvenile glaucoma, prolonged medical therapy, steroid induced glaucoma, post penetrating keratoplasty glaucoma and developmental glaucoma) had a significantly poorer surgical success rate (88% and 78%) than eyes with one risk factor (100%). 0.4 mg/ml MMC used sub-sclerally had a statistically similar effect on lowering the IOP as 0.2 mg/ml in all groups. The rate of complications was significantly higher in the 0.4 mg/ml subgroup. Conclusions: The presence of more than one preoperative ocular risk factor, affects the surgical success of MMC augmented trabeculectomy in high-risk cases. Because of the significantly higher rate of complications with the higher dose of MMC, this should be used sparingly, only in cases with more than two risk factors.

Original languageEnglish (US)
Pages (from-to)92-96
Number of pages5
JournalJournal of postgraduate medicine
Volume48
Issue number2
StatePublished - Apr 1 2002

Fingerprint

Trabeculectomy
Mitomycin
Glaucoma
Intraocular Pressure
Neovascular Glaucoma
Corneal Opacity
Penetrating Keratoplasty
Chi-Square Distribution
Cohort Studies
Odds Ratio
Steroids
Prospective Studies

Keywords

  • Mitomycin-C
  • Risk factors
  • Success rate
  • Trabeculectomy

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Cumulative effect of risk factors on short-term surgical success of mitomycin augmented trabeculectomy. / Agarwal, H. C.; Sharma, T. K.; Sihota, R.; Gulati, V.

In: Journal of postgraduate medicine, Vol. 48, No. 2, 01.04.2002, p. 92-96.

Research output: Contribution to journalArticle

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N2 - Context: Risk factors for failure of trabeculectomy may have a cumulative effect on the outcome. Aims: To study the effect of preoperative ocular risk factors on the surgical outcome of trabeculectomy augmented with 2 commonly used doses of Mitomycin C. Settings and Design: In a prospective cohort study, cases were recruited over an 18 month period. 92 eyes of 83 patients with one to three known risk factors for failure of trabeculectomy underwent Mitomycin-C (MMC) augmented trabeculectomy. Methods and Material: Trabeculectomy was done with a randomly chosen MMC dose of 0.2 mg/ml or 0.4 mg/ml. All cases were followed up for a period of at least 3 months. Surgical success was defined as the lowering of intraocular pressure (IOP) below 21 mmHg during the follow up period. Statistical Analysis Used: Chi square test, paired t test, odds ratio, effect size. Results: Eyes with two or three risk factors (out of aphakic glaucoma, failed trabeculectomy, neovascular glaucoma, post uveitic glaucoma, traumatic glaucoma, adherent leucoma, juvenile glaucoma, prolonged medical therapy, steroid induced glaucoma, post penetrating keratoplasty glaucoma and developmental glaucoma) had a significantly poorer surgical success rate (88% and 78%) than eyes with one risk factor (100%). 0.4 mg/ml MMC used sub-sclerally had a statistically similar effect on lowering the IOP as 0.2 mg/ml in all groups. The rate of complications was significantly higher in the 0.4 mg/ml subgroup. Conclusions: The presence of more than one preoperative ocular risk factor, affects the surgical success of MMC augmented trabeculectomy in high-risk cases. Because of the significantly higher rate of complications with the higher dose of MMC, this should be used sparingly, only in cases with more than two risk factors.

AB - Context: Risk factors for failure of trabeculectomy may have a cumulative effect on the outcome. Aims: To study the effect of preoperative ocular risk factors on the surgical outcome of trabeculectomy augmented with 2 commonly used doses of Mitomycin C. Settings and Design: In a prospective cohort study, cases were recruited over an 18 month period. 92 eyes of 83 patients with one to three known risk factors for failure of trabeculectomy underwent Mitomycin-C (MMC) augmented trabeculectomy. Methods and Material: Trabeculectomy was done with a randomly chosen MMC dose of 0.2 mg/ml or 0.4 mg/ml. All cases were followed up for a period of at least 3 months. Surgical success was defined as the lowering of intraocular pressure (IOP) below 21 mmHg during the follow up period. Statistical Analysis Used: Chi square test, paired t test, odds ratio, effect size. Results: Eyes with two or three risk factors (out of aphakic glaucoma, failed trabeculectomy, neovascular glaucoma, post uveitic glaucoma, traumatic glaucoma, adherent leucoma, juvenile glaucoma, prolonged medical therapy, steroid induced glaucoma, post penetrating keratoplasty glaucoma and developmental glaucoma) had a significantly poorer surgical success rate (88% and 78%) than eyes with one risk factor (100%). 0.4 mg/ml MMC used sub-sclerally had a statistically similar effect on lowering the IOP as 0.2 mg/ml in all groups. The rate of complications was significantly higher in the 0.4 mg/ml subgroup. Conclusions: The presence of more than one preoperative ocular risk factor, affects the surgical success of MMC augmented trabeculectomy in high-risk cases. Because of the significantly higher rate of complications with the higher dose of MMC, this should be used sparingly, only in cases with more than two risk factors.

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KW - Success rate

KW - Trabeculectomy

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