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Abstract
Purpose
To investigate whether mitomycin C (MMC) results in an improved trabeculectomy outcome in primary open-angle glaucoma patients who preoperatively used prostaglandin (PG) ophthalmic solution.
Methods
The subjects consisted of three groups of primary open-angle glaucoma patients who underwent trabeculectomy. Group A consisted of 17 patients who did not use PG ophthalmic solution preoperatively, while Group B consisted of ten patients who used PG ophthalmic solution for at least three months but were not treated with MMC during the operation, and Group C consisted of 14 patients who used PG ophthalmic solution for at least three months and were treated with MMC during the operation. The operation was considered successful when the intraocular pressure ranged from 6 to 18 mmHg, regardless of application of ocular hypotensive agents.
Results
Four years after the operation, differences of the cumulative success rate between Group A and B (p = 0.008) and between Group B and Group C (p = 0.036) were statistically significant, but differences between Group A and C were not (p = 0.813) (Log rank test results).
Conclusions
The cumulative success rate of trabeculectomy in primary open-angle glaucoma patients who used PG ophthalmic solution for at least three months was lower than that of patients who did not use PG ophthalmic solution. However, the intraoperative administration of MMC increased the cumulative success rate of trabeculectomy in patients who did use PG ophthalmic solution for at least three months to a level similar to patients who did not use PG ophthalmic solution.
Figures and Tables
Figure 1
Mean intraocular pressure (IOP) in Groups A, B, C whose IOP was 18 mm Hg or below. Postoperative IOP exhibited a statistically significant difference between the 3 groups during the follow-up periods, except at 1, 30, and 36 months (p = 0.14, 0.65, 0.14, Kruskal-W allis test). (Group A: Patients used neither preoperative prostaglandin ophthalmic solution nor mitomycin C during the trabeculectomy; Group B: Patients used preoperative prostaglandin ophthalmic solution for more than 3 months, but did not use mitomycin C during the trabeculectomy; Group C: Patients used both preoperative prostaglandin ophthalmic solution for more than 3 months and mitomycin C during the trabeculectomy).
Figure 2
Postoperative profiles of drug requirements for Groups A, B, C whose IOP were 18 mm Hg or below. There was no statistical significance in the number of postoperative antiglaucoma drugs between the 3 groups during follow-up (p > 0.05, Kruskal-W allis test). (Group A: Patients used neither preoperative prostaglandin ophthalmic solution nor mitomycin C during the trabeculectomy; Group B: Patients used preoperative prostaglandin ophthalmic solution for more than 3 months, but did not use mitomycin C during the trabeculectomy; Group C: Patients used both preoperative prostaglandin ophthalmic solution for more than 3 months and mitomycin C during the trabeculectomy).
Figure 3
Postoperative cumulative success rates of Group A and B. The results of Group A were higher than Group B, and were statistically significant (p = 0.008, Log rank test). (Group A: Patients used neither preoperative prostaglandin ophthalmic solution nor mitomycin C during trabeculectomy; Group B: Patients used preoperative prostaglandin ophthalmic solution for more than 3 months, but did not use mitomycin C during trabeculectomy).
Figure 4
Postoperative cumulative success rates of Group B and C. Group C was higher than Group B, and this was statistically significant (p = 0.036, Log rank test). (Group B: Patients used preoperative prostaglandin ophthalmic solution for more than 3 months, but did not use mitomycin C during trabeculectomy; Group C: Patients used both preoperative prostaglandin ophthalmic solution for more than 3 months and mitomycin C during trabeculectomy).
Figure 5
Postoperative cumulative success rates of Group A and C. There was no statistical significance between the postoperative cumulative success rates between the groups (p = 0.813, Log rank test). (Group A: Patients used neither preoperative prostaglandin ophthalmic solution nor mitomycin C during trabeculectomy; Group C: Patients used both preoperative prostaglandin ophthalmic solution for more than 3 months and mitomycin C during trabeculectomy).
Table 1
Demographic and baseline characteristics
Values are presented as number or mean ± SD.
Group A: No PG treatment preoperatively; Group B: PG treatment preoperatively, but did not use mitomycin C during trabeculectomy; Group C: PG treatment preoperatively and used mitomycin C during trabeculectomy.
IOP = intraocular pressure; BCVA = best corrected visual acuity; PG = prostaglandin ophthalmic solution.
*Kruskal-Wallis test; †Fisher's exact test; ‡Mann-Whitney test.
Table 2
Intraocular pressure (mean ± SD) of patients whose postoperative intraocular pressure was 18 mm Hg or below during follow-up
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