J Korean Ophthalmol Soc.  2010 Apr;51(4):575-580. 10.3341/jkos.2010.51.4.575.

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

• Kim JY
• Shim HS
• Kim HK
• Sohn YH

• KMID: 2213401
• DOI: http://doi.org/10.3341/jkos.2010.51.4.575

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 anti-glaucoma 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.

Keyword

Ahmed valve implantation; Trabeculectomy with mitomycin C; Uveitic glaucoma

MeSH Terms

Diabetes Mellitus
Eye
Glaucoma
Glaucoma, Open-Angle
Humans
Intraocular Pressure
Mitomycin
Postoperative Period
Retrospective Studies
Trabeculectomy
Uveitis
Mitomycin

Figure

• 

  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.

Reference

References

1. Rachmiel R, Trope GE, Buys YM, et al. Ahmed glaucoma valve implantation in uveitic glaucoma versus open-angle glaucoma patients. Can J Ophthalmol. 2008; 43:462–7.

2. Papadaki TG, Zacharopoulos IP, Pasquale LR. et al. abdominal abdominal of Ahmed glaucoma valve implantation for uveitic glaucoma. Am J Ophthalmol. 2007; 144:62–9.

3. Kok H, Barton K. Uveitic glaucoma. Ophthalmol Clin North Am. 2002; 15:375–87.

4. Stavrou P, Misson GP, Rowson NJ, Murray PI. Trabeculectomy in uveitis. Ocul Immunol Inflam. 1995; 3:209–16.

5. Hill RA, Nguyen QH, Baerveldt G. et al. Trabeculectomy and Molteno implantation for glaucomas associated with uveitis. Ophthalmology. 1993; 100:903–8.

6. Towler HM, McCluskey P, Shaer B, Lightman S. abdominal fol-low-up of trabeculectomy with intraoperative 5-fluorouracil for uveitis-related glaucoma. Ophthalmology. 2000; 107:1822–8.

7. Noble J, Derzko-Dzulynsky L, Rabinovitch T, Birt C. Outcome of trabeculectomy with intraoperative mitomycin C for uveitic glaucoma. Can J Ophthalmol. 2007; 42:89–94.

8. Novak-Laus K, Mandić Z, Iveković R, et al. Trabeculectomy with mitomycin C in glaucoma associated with uveitis. Coll Antropol. 2005; 29:17–20.

9. Yalvac IS, Sungur G, Turhan E, et al. Trabeculaectomy with abdominal C in uveitic glaucoma associated with Behcet disease. J Galucoma. 2004; 13:450–3.

10. Watson PG. Surgery of glaucomas. Br J Ophthalmol. 1972; 56:299–306.

11. Chen CW. Enhanced intraocular pressure controlling abdominal of trabeculectomy by local application of mytomycin C. Trans Asia Pac Acad Ophthalmol. 1983; 9:172–7.

12. Palmer SS. Mitomycin as adjunct chemotherapy with trabecuectomy. Ophthalmology. 1991; 98:317–21.

13. Topouzis F, Coleman AL, Choplin N, et al. Follow-up of the original cohort with the Ahmed glaucoma valve implant. Am J Ophthalmol. 1999; 128:198–204.

14. Huang MC, Netland PA, Coleman AL, et al. Intermediate-term clinical experience with the Ahmed Glaucoma Valve implant. Am J Ophthalmol. 1999; 127:27–33.

15. Lee HJ, Choi KR. Outcome of Ahmed Valve Implantation in Refractory Glaucoma. J Korean Ophthalmol Soc. 2006; 47:933–40.

16. Lee SH. Ma KT, Hong YJ. Outcome of Ahmed Valve Implantation in Refractory Glaucoma. J Korean Ophthalmol Soc. 2007; 48:83–90.

17. Lee JK, Ryu YH. The Effect of Antiglaucoma Medication on Cultured Human Conjunctival Epithelial Cells. J Korean Ophthalmol Soc. 2006; 47:1811–8.

18. Arici MK, Arici DS, Topalkara A, Güler C. Adverse effects of topical antiglaucoma drugs on the ocular surface. Clini Experimen Ophthalmol. 2000; 28:113–7.

19. Levene RZ. Glaucomatous filtering surgery. Factors that abdominal pressure control. Ophthalmic Surg. 1984; 15:475–83.

20. Skuta GL, Parrish RK 2nd. Wound healing in glaucoma filtering surgery. Surv Ophthalmol. 1987; 32:149–70.

21. Kwon MJ, Park JH. Impaired wound healing in diabetes mellitus. Korean Diabetes J. 2009; 33:83–90.

22. Lee DS, Cha SC. Comparison of long-term results of primary abdominal with mitomycin C in juvenile-onset and adult-onset primary open angle glaucoma. J Korean Ophthalmol Soc. 2002; 43:2466–74.S.

23. Lee TY, Lee JH, Cha SC. Trabeculectomy with mitomycin C abdominal Ahmed valve implantation in pseudophakic glaucomatous eyes. J Korean Ophthalmol Soc. 2008; 49:293–302.

24. Shileds MB, Scroggs MW, Sloop CM, Simmons RB. Clinical and histologic observations concerning hypotony after abdominal with adjunctive mitomycim C. Am J Ophthalmol. 1993; 116:673–83.

25. Blindlish R, Condon GP, Schlosser JD, et al. Efficacy and safety of mitomycin-C in primary trabeculectomy: five-year follow-up. Ophthalmology. 2002; 109:1336–41.

26. Wilson MR, Mendis U, Pailwal A, Haynatzka V. abdominal fol-low-up of primary glaucoma surgery with Ahmed glaucoma valve implant ersus trabeculectomy. Am J Ophthalmol. 2003; 136:464–70.

27. Wilson MR, Mendis U, Smith SD, Pailwal A. Ahmed glaucoma valve implant vs trabeculectomy in the surgical treatment of abdominal: a randomized clinical trial. Am J Ophthalmol. 2000; 130:267–73.