Br J Ophthalmol 1999;83:151-156 ( February )
Filtration procedures supplemented with mitomycin C in the
management of childhood glaucoma
Augusto Azuara-Blanco,* a
Richard P Wilson,a
George L Spaeth,a
Courtland M Schmidt,a
James J Augsburgerb
a Glaucoma Service,
Wills Eye Hospital, Jefferson Medical College, Philadelphia, USA, b Retina Service, Wills Eye
Hospital, Jefferson Medical College, Philadelphia, USA
Correspondence to: Augusto Azuara-Blanco, MD, Department of Ophthalmology, Queen's
Medical Centre, Nottingham NG7 2UH.
Accepted for publication 30 July 1998
AIMS
To evaluate the
outcome of filtering procedures supplemented with mitomycin C in
children with glaucoma.
METHODS
All patients
aged 17 or younger with glaucoma who underwent filtering surgery
supplemented with mitomycin C at a tertiary care centre (n=21) during a
5 year interval (1992 and 1996) were included. One eye for each patient
was entered into the analysis. The postoperative intraocular pressure
(IOP), use of antiglaucoma medications, clinical stability of glaucoma,
complications, and visual acuity were retrospectively evaluated.
Kaplan-Meier survival curves were used to estimate the probability of success.
RESULTS
At the time of
surgery mean age was 5.7 (SD 5.0) years. The most common diagnoses were
trabeculodysgenesis (n=6) and aphakic glaucoma (n=8). Mean IOP before
surgery was 35.7 (10.5) mm Hg. Average length of follow up was 18.6 (14.7) months. The probability of having IOP less than 21 mm Hg with no
antiglaucoma medications and with clinically stable glaucoma 1 year
after surgery was 76.9% in phakic eyes (n=13) and 0% in aphakic eyes
(n=8). A phakic patient with Sturge-Weber's syndrome had choroidal
effusion after surgery that resolved spontaneously. In the aphakic
group one patient had retinal detachment and another developed an
encapsulated bleb. Visual acuity deteriorated in one patient.
CONCLUSION
A guarded
filtration procedure with mitomycin C is relatively successful in
phakic children with glaucoma, but unsuccessful in aphakic ones.
Keywords:
mitomycin C;
filtration
procedure;
children;
glaucoma
*
Associated
with the Department of Ophthalmology, Queen's Medical Centre,
University of Nottingham.
© 1999 by British Journal of Ophthalmology