Journal of Yeungnam Medical Science

Original Article

Trabeculectomy Using Mitomycin C in Aphakic and Pseudophakic Eyes.: Jun hyuk Son, Soon Cheol Cha; Yeungnam Univ J Med. 2007;24(2):232-242. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2.232

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Abstract PDF: BACKGROUND
The safety and efficacy of trabeculectomy with Mitomycin C (MMC) for surgical treatment in aphakic and pseudophaic eyes were retrospectively evaluated. MATERIALS AND METHODS: The authors reviewed 51 eyes of 45 patients who had been followed up for at least 6 months after trabeculectomy using MMC for aphakic and pseudophakic eyes. The success rate and complications were analyzed. The success criteria included intraocular pressures of 21 mmHg or less with or without glaucoma medications and no loss of light perception. Surgical failure was defined as a postoperative loss of light perception in patients with preoperative vision better than light perception, additional glaucoma surgery, or phthisis bulbi in patients with preoperative vision of no light perception. RESULTS: The average follow up period was 27.7 months and the intraocular pressure was controlled under 21 mmHg in 36 eyes of 51 (70.6%) after the procedure with or without medication for glaucoma. Using the Kaplan-Meier survival analysis, the cumulative success rate at the 3-, 6-, 12-, 24- and 36-month intervals were 98.0%, 94.1%, 91.9%, 83.4% and 75.5%, respectively. The complications observed were hyphema (4 eyes), serous choroidal detachment (4 eyes), hypotony (3 eyes), and endophthalmitis (1 eye). CONCLUSION: Trabeculectomy using Mitomycin C for the treatment of aphakic and pseudophaic eyes was safe and effective.

Review

Surgical Management of Coexisting Glaucoma and Cataract.: Soon Cheol Cha; Yeungnam Univ J Med. 2004;21(1):12-22. Published online June 30, 2004; DOI: https://doi.org/10.12701/yujm.2004.21.1.12

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Abstract PDF: The management of coincident glaucoma and cataract is not only a common clinical challenge but also an important research topic in the ophthalmic surgical field. The purpose of this article is to compare the different surgical options on the basis of their achievable postoperative intraocular pressure (IOP) control, success rates, and complication rates reported in the related literature, and to give advice on how to manage typical situations of patients with both glaucoma and cataract. Main topics were focused on indications and rationale of 3 surgical options (only cataract surgery first and later trabeculectomy, only trabeculectomy first and later cataract surgery, or simultaneous combined surgery). Modern clear corneal cataract extraction techniques resulted in a modest intermediate-term reduction of IOP and has considerably improved the success rates of combined glaucoma and cataract surgery. It also enabled future trabeculectomy to be successfully performed at a later date if necessary. Trabeculectomy alone achieved better IOP regulation than phacotrabeculectomy (combined surgery), but subsequent cataract surgery may compromise preexisting filtering bleb. Combined surgery augmented with mitomycin C achieved a lower IOP than combined surgery alone but had a higher complication rate. In conclusion, the choice of the preferred surgical method should be determined according to the target pressure, the amount of glaucomatous damage, and the grade of visual disturbance caused by the cataract. Phacotrabeculectomy with adjunctive mitomycin C offers visual improvement and achieves the best IOP lowering of all types of combined glaucoma and cataract surgery currently used but is associated with potentially sight-threatening complications.

Original Article

The Results and Prognostic Factors of Mitomycin C Trabeculectomy in Neovascular Glaucoma.: Yun Tae Kim, Soon Cheol Cha; Yeungnam Univ J Med. 2002;19(2):126-135. Published online December 31, 2002; DOI: https://doi.org/10.12701/yujm.2002.19.2.126

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Abstract PDF: BACKGROUND
Neovascular glaucoma is common secondary glaucoma at high risk for failure of glaucoma filtering surgery. Recently, trabeculectomy with adjunctive mitomycin C trabeculectomy has been tried to improve the surgical success rate of conventional trabeculectomy. But, the long-term effects of mitomycin C trabeculectomy for neovascular glaucoma are unknown. Thus, we evaluated the long-term effects of mitomycin C trabeculectomy and its prognostic factors influencing the outcome. MATERIALS AND METHODS: Medical records of 62 eyes of 55 neovascular glaucoma who had undergone mitomycin C trabeculectomy were retrospectively reviewed. Surgical success was defined as intraocular pressures of 21 mmHg or less with or without glaucoma medications and no loss of light perception. Surgical failure was defined as postoperative loss of light perception in patients with preoperative vision better than light perception, additional glaucoma surgery, or phthisis bulbi in patients with preoperative vision of no light perception. RESULTS: Postoperative success was obtained in 37 (60%) out of 62 eyes after mean follow- up period of 23.9+/-16.2 months. Using Kaplan-Meier survival analysis, cumulative success rate at the 6-, 12-, 24- and 36-month intervals were 85%, 71%, 57% and 52%, respectively. Success rate was greater in eyes with diabetic retinopathy than other causes(p=0.005) and in eyes with preoperative panretinal photocoagulation(PRP) than without PRP(p=0.015). However, Cox proportional hazard regression analysis revealed that preoperative PRP was not a significant risk factor for surgical failure. CONCLUSION: Prognosis of neovascular glaucoma caused by diabetic retinopathy was better than that caused by the other disorders following mitomycin C trabeculectomy. The author would suggest that mitomycin C trabeculectomy could be effective and relatively safe as the first procedure of choice before performing glaucoma drainage device implantation or cyclodestructive procedure.

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