Comparison of Outcome of Trabeculectomy With Mitomycin C and Ahmed Valve Implantation for Uveitic Glaucoma

Joo Yeon Kim; Hyoung Sub Shim; Hwang Ki Kim; Yong Ho Sohn

doi:10.3341/jkos.2010.51.4.575

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Kim, Shim, Kim, and Sohn: Comparison of Outcome of Trabeculectomy With Mitomycin C and Ahmed Valve Implantation for Uveitic Glaucoma

Original Article

J Korean Ophthalmol Soc 2010;51(4):575-580.

Published online: 25 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.4.575

Comparison of Outcome of Trabeculectomy With Mitomycin C and Ahmed Valve Implantation for Uveitic Glaucoma

Joo Yeon Kim, MD, Hyoung Sub Shim, MD, Hwang Ki Kim, MD, Yong Ho Sohn, MD, PhD

Department of Ophthalmology, Konyang University, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Seoul, Korea

Address reprint requests to Yong Ho Sohn, MD, PhD Department of Ophthalmology, Kim's Eye Hospital #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul 150-034, Korea TEL: 82-2-2639-7777, FAX: 82-2-2633-3976, E-Mail: yhsohn@konyang.ac.kr

Received 3 November 2009 Accepted 9 March 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To assess and compare the clinical outcomes of primary trabeculectomy with mitomycin C and Ahmed valve implantation for secondary open-angle glaucoma following uveitis.

Methods

This study was conducted retrospectively on 30 eyes of 25 patients with open-angle glaucoma secondary to uveitis that had undergone trabeculectomy with mitomycin C and 33 eyes of 24 patients that had undergone Ahmed valve implantation. The clinical outcome indicators used in this study were intraocular pressure (IOP), number of antiglaucoma agents, surgical success rate and occurrence of complications.

Results

Mean IOP and surgical success rate in patients who had undergone trabeculectomy with mitomycin C after a 12 month postoperative period were 14.0±8.2 mmHg and 76.7%, respectively, while those of patients with Ahmed valve implantation were 13.2±7.7 mmHg and 81.8%. The data did not show clinical significance. There was greater risk of surgical failure in patients at a younger age and/or with diabetes mellitus in cases of having gone through trabeculectomy with mitomycin C.

Conclusions

Both trabeculectomy with mitomycon C and Ahmed valve implantation can be considered as primary surgical treatments for patients with open-angle glaucoma secondary to uveitis. However, trabeculectomy with mitomycin C should only be applied to a limited extent in patients that are young and/or have diabetes mellitus.

Keywords: Ahmed valve implantation, Trabeculectomy with mitomycin C, Uveitic glaucoma

References

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Figure 1.

Kaplan-Meier survival curve showing the cumulative probability of success following trabeculectomy with mitomycin C and Ahmed valve implantation. These two curves are not significantly different (p=0.223, log rank test).

Figure 2.

Comparison of intraocular pressure (IOP) of trabeculectomy with mitomycin C and Ahmed valve implantation according to each follow-up periods. IOP of Ahmed valve implantation was significantly lower than trabeculectomy with mitomycin C after post-op 1day and 1 week. But, IOP of trabeculectomy with mitomycin C was maintained more stably during follow-up periods.

Table 1.

Basic demographics of patients

	Trabeculectomy with mitomycin C (N=30)	Ahmed valve implantation(N=33)	p-value
Mean age, yr (SD)	50.60 (9.94)	48.21 (13.3)	0.429^*
Male/Female	22/8	23/10	0.787^‡
OD/OS	20/10	23/10	0.504^‡
Previous ocular surgery	21/9	21/12	0.395^‡
Duration of uveitis, yr (SD)	3.75 (4.14)	2.56 (2.88)	0.400^†
Duration of use of preoperative antiglaucoma agents, yr (SD)	0.70 (0.96)	1.85 (2.16)	0.027^†
Duration from diagnosis to surgery, yr (SD)	1.10 (2.07)	2.01 (2.45)	0.099^†
Periods of follow up, yr (SD)	3.34 (1.95)	3.52 (2.15)	0.770^†

^* t-test

^† Mann-Whitney U test

^‡ Chi-square test.

Table 2.

Comparison of preoperative vs. postoperative number of anti-glauco

	Trabeculectomy with mitomycin C (N=30)	Ahmed valve implantatio (N=33)	n p-value
Number of antiglaucoma agents, preoperative (SD)	1.77 (1.07)	1.88 (0.99)	0.692^*
Number of antiglaucoma agents, postoperative 12 months (SD)	0.46(0.81)	0.83 (0.88)	0.085^†

^* t-test

^† Mann-Whitney U test.

Table 3.

Analysis of parameters which could influence on succeed of trabeculectomy with mitomycin C

	Exp(B)	p-value
Age	0.888	0.032
Duration of uveitis	0.664	0.375
Duration of use of preoperative antiglaucoma agents	0.396	0.965
Number of preoperative antiglaucoma agents	0.783	0.141
Preoperative intraocular pressure	0.032	0.733
Duration from diagnosis to surgery	0.031	0.246
Previous ocular surgery	0.077	0.112
History of diabete mellitus	0.476	0.014

Binary Logistic Regression.

Table 4.

Analysis of parameters influencing success of Ahmed valve implantation

	Exp (B)	p-value
Age	0.025	0.603
Duration of uveitis	0.218	0.616
Duration of preoperative use of antiglaucoma agents	0.743	0.745
Number of preoperative antiglaucoma agents	0.388	0.536
Preoperative intraocular pressure	0.040	0.519
Duration from diagnosis to surgery	0.714	0.700
Previous ocular surgery	0.668	0.697
History of diabetes mellitus	0.305	0.497

Binary logistic regression.

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