Trabeculectomy surgery augmented with intra-Tenon injection of mitomycin C.

PURPOSE: To describe a novel approach to mitomycin C (MC) application during trabeculectomy surgery and to report the 1-year results of surgery using this technique.

METHODS

One hundred and eight consecutive trabeculectomies and phaco-trabeculectomies using MC were performed by a single consultant surgeon, using a standardized technique. This technique involved injecting MC into the Tenon's layer during the procedure, rather than applying it directly to the under-surface of the conjunctiva.

RESULTS

Preoperative mean intraocular pressure (IOP) was 23.6 +/- 5.8 mmHg. Mean IOP 12 months following surgery was 12.2 +/- 3.9 mmHg. Seventy-six eyes (70.3%) had an IOP less than 2/3 listing IOP at 12 months without the need for anti-glaucoma medication. Ninety-three eyes (86%) had an IOP <21 mmHg, 79 (73%) had an IOP <16 mmHg and 62 (57%) had an IOP <14 mmHg without anti-glaucoma medication at 12 months. Transient complications included hyphaema, bleb leak and choroidal detachment in 14.8%, 5.6% and 15.7% of cases, respectively. Hypotony (defined as IOP <7 mmHg, excluding the first day postoperatively) was seen in 21.3% of cases. At 12 months, 21 eyes (19.4%) had cystic blebs and five (4.6%) had Tenon's cysts with an IOP greater than 20 mmHg.

CONCLUSION

A novel means of applying intraoperative MC is described. The 12-month outcome data show it to be an effective technique that compares favourably with others in the literature.