Trabeculectomy with large area mitomycin-C application as a first-line treatment in advanced glaucoma: retrospective review

AIM: To evaluate the outcomes of trabeculectomy with large area mitomycin-C(MMC) application as a first line treatment in advanced glaucoma. ·METHODS: The records of 55 patients with severe visual field defects undergoing trabeculectomy were retrospectively reviewed. The patients were classified as first-line therapy to either early trabeculectomy(initial trabeculectomy-Group 1) or long term medical therapy followed by trabeculectomy(primary trabeculectomy-Group 2). Trabeculectomy was performed with large-area MMC application. Intraocular pressure(IOP) values,visual acuities,mean deviations,morphology and function of the blebs,necessity for anti-glaucomatous medications and surgical complications were reported. ·RESULTS: There were 20 eyes of 18 patients in Group 1 and 37 eyes of 37 patients in Group 2. The mean preoperative IOPs in Groups 1 and 2 were 40.2±10.0mmHg(27-68mmHg) and 29.0±4.4mmHg(21-41mmHg),respectively(P=0.001). Average preoperative mean deviations(MD) in Groups 1 and 2 were 17.4±2.8dB(13.3-23dB) and 17.9± 2.4dB(13.7-23.2dB),respectively(P=0.441). Postoperative IOPs significantly decreased and were comparable in both Groups. The mean number of medications was significantly higher in Group 2(P =0.005). No cystic bleb formation was observed in Group 1,whereas 4 patients from Group 2(10.8%) developed cystic bleb(P =0.040). No visually devastating complication has occurred in both Groups. ·CONCLUSION: Initial trabeculectomy with large areaMMC application might be applied in patients with advanced glaucoma with low complication rates. Long-term topically applied anti-glaucomatous medications seem to increase the risk of cystic bleb formation.

Apoptosis in the iris and trabecular meshwork of medically treated and untreated primary open angle glaucoma patients

AIM:To compare the trabecular meshwork(TM)and iris apoptosis of treated and untreated primary open angle glaucoma(POAG)patients.METHODS:Eight treatment-naive,newly diagnosed(group 1)and 11 medlcaiy treated(group 2)patients with POAG were included in the study.Each patient underwent a limbus-based trabeculectomy.The TM and peripheral iris specimens were dissected out and were snap-frozen in liquid nitrogen and stored at-80t until they were assayed.Apoptosis in each group was assesed by TUNEL method.RESULTS:The mean patient age was 60.6±5.8 years(53-68 years)vs 58.9±8.9 years(47-70 years)in group 1and group 2(P=0.859).The mean treatment time in group 2 was 22.2±7.3 months(12-34 months).Apoptotic indexes in TM and iris were significantly higher in POAG patients using medication(group 2)compared to treatment-naive POAG patients(group 1)(P=0.004,0.015;respectively).CONCLUSION:Long term administration of topical antiglaucoma medications causes additional toxic effects on TM.