Our results of large area mitomycin C application trabeculectomy in cases with advanced glaucoma

Yıl 2013, , 597 - 600, 01.12.2013

Mutlu Cihan Dağlıoğlu Esra Ayhan Tuzcu Nilüfer İlhan Mesut Coşkun Emre Ayıntap Uğurcan Keskin Özgür İlhan Hilal Kahraman

https://doi.org/10.5798/diclemedj.0921.2013.04.0339

Öz

Objective: To evaluate large area Mitomycin-C (MMC) applied trabeculectomy results in advanced glaucoma patients in which targeted intraocular pressure (IOP) can not be achieved with maximum medical therapy. Methods: 41 eyes of 35 advanced glaucoma patients that can not be controlled with medical treatment were included to the study. Large area MMC application was applied for 2 minutes in 0.2 mg/ml concentration. The mean follow-up period was 28 months (24-36). All of the cases were advanced glaucoma patients and 21mmHg IOP level could not be achieved in spite of maximum treatment with three drugs. Results: Of the 35 patients that were included to study, 19 were male and 16 were female and the mean age was 52.5±1.8 years (range, 45-73). Twenty-seven of eyes were primary open angle glaucoma, 11 was pseudoexfoliative glaucoma, 3 were angle closure glaucoma. In 5 eyes (12.1%) there were early hypotonia. Additional suturation was made in 2 eyes with hypotonia. Two eyes were treated with tight patching. Suture addition was made in 1 eye with choroid effusion. Cataract was developed in 4 eyes. There were 3 cystic bleb (7.3%) and they were treated with needle application. Thin avascular bleb was developed in 10 eyes (24.4%). In other eyes (68.3%) there were thin diffuse bleb formations. When targeted IOP was considered as 15 mmHg, targeted IOP was achieved in 36 (87.8%) eyes. Conclusion: We suggest that trabeculectomy with large area MMC application is an effective choice in advanced glaucoma patients in which targeted IOP can not be achieved with maximum medical treatment.

Anahtar Kelimeler

Mitomycin-C, trabeculectomy, bleb

İleri evre glokomlu olgularda geniş alan mitomisin C uygulamalı trabekülektomi sonuçlarımız

Öz

Amaç: Maksimum tıbbi tedavi ile hedef göziçi basıncı (GİB) sağlanamayan ileri evre glokomlu hastalarda geniş alan Mitomisin-C (MMC) uygulamalı trabekülektomi sonuçlarının değerlendirilmesi amaçlandı. Yöntemler: Çalışmaya medikal tedavi ile kontrol altına alınamayan ileri evre glokomu olan 35 hastanın 41 gözü dahil edilmiştir. Geniş alan MMC uygulaması 0,2 mg/ml konsantrasyonda 2 dk süre ile uygulanmıştır. Ortalama izlem süresi 28 aydır (24-36). Olguların hepsi maksimum 3\'lü tedaviye rağmen GİB 21 mmHg altına düşmeyen ileri derecede glokomu olan hastalardır. Bulgular: Çalışmaya dahil edilen 35 hastanın 19\'u erkek 16\'sı kadın idi ve yaş ortalaması 52,5±1,8 yıl (45-73) olarak bulundu. Opere edilen gözlerin 27\'si primer açık açılı glokom, 11\'i psödoeksfolyatif glokom, 3\'ü açı kapanması glokomu idi. 5 (%12,1) gözde erken dönem hipotoni gelişmiştir. Hipotoni gelişen 2 göze ek sütür konulmuştur. İki göz sıkı bandaj kapama ile tedavi edilmiştir. Koroid effüzyonu gelişen 1 göze ek operasyonla sütür eklenmiştir. Dört gözde katarakt gelişmiştir. 3 gözde kistik bleb (%7,3) görülmüş iğneleme ile tedavi edilmiştir. On gözde (%24,4) ince avasküler bleb gelişmiştir. Diğer gözlerde (%68,3) ince diffüz ve fonksiyonel bleb izlenmiştir. Hedeflenen GİB 15mmHg olarak değerlendirildiğinde gözlerin 36\'sında (%87,8) hedeflenen GİB değerine ulaşılmıştır Sonuç: Maksimum tıbbi tedavi ile hedef GİB sağlanamayan ileri evre glokomlu hastalarda, geniş alan MMC uygulamalı trabekülektomi yönteminin etkili bir seçenek olabileceği düşünüldü.

Anahtar Kelimeler

Mitomisin-C, trabekülektomi, bleb

Kaynakça

• Önol M, Pehlivanlı Z, Hasanreisoğlu H. Trabekülektomide başarın arttırılması: geniş alan mitomisin C uygulaması. Glo-Kat 2006;1:7-12.
• Lama PJ, Fechtner RD. Antifibrotics and wound healing in glaucoma surgery. Surv Ophthalmol 2003;48:314-346.
• Maquet JA, Dios E, Aragón J, et al. Protocol for mitomy- cin C use in glaucoma surgery. Acta Ophthalmol Scand 2005;83:196-200.
• Storr-Paulsen T, Norregaard JC, Ahmed S, Storr-Paulsen A. Corneal endothelial cell loss after mitomycin C-augmented trabeculectomy. J Glaucoma 2008;17:654-657.
• Salmon SE, Sartorelli AC. Cancer chemotherapy, in Katsung: Basic and Clinical Pharmacology, 4th edition. Norwalk: CT Appleton and Lange,1987:680–681.
• Jampel HD: Effect of brief exposure to mitomyin C on vi- ability and proliferation of cultured human Tenon’s capsule fibroblast. Ophthalmology 1992;99:1471-1476.
• Zacharia PT, Deppermann SR, Schuman JS. Ocular hypoto- ny after trabeculectomy with mitomycin C. Am J Ophthal- mol 1993;116:314-326.
• Cohen JS, Novack GD, Li ZL: The role of mitomycin C treat- ment duration and previous intraocular surgery on the suc- cess of trabeculectomy surgery. J Glaucoma 1997;6:3-9.
• Kim YY, Sexton RM, Shin DH, et al. Outcomes of primary phakic trabeculectomies without versus with 0.5-1-min- ute versus 3-5-minute mitomycin C. Am J Ophthalmol 1998;126:755–762.
• Flynn WJ, Carlson DW, Bifano SL. Mitomycin trabecu- lectomy: the microsurgical sponge difference. J Glaucoma 1995;4:86-90.
• Cordeiro MF, Constable PH, Alexander RA, et al. Effect of varying the mitomycin-C treatment area in glaucoma filtration surgery in the rabbit. Invest Ophthalmol Vis Sci 1997;38:1639-1646.
• Hu CY, Matsuo H, Tomita G, et al. Clinical characteristics and leakage of functioning blebs after trabeculectomy with mitomycin-C in primary glaucoma patients. Ophthalmol- ogy 2003;110:345-352.
• Sari A, Onol M, Ozdek S, et al. Effect of mitomycin C on ciliary body and intraocular pressure with various applica- tion depths: an experimental study. Clin Experiment Oph- thalmol 2005;33:169-175.
• Mietz H. The toxicology of mitomycin C on the ciliary body. Curr Opin Ophthalmol1996;7:727-729.
• Schraermeyer U, Diestelhorst M, Bieker A, et al. Morpho- logic proof of the toxicity of mitomycin C on the ciliary body in relation to different application methods. Graefes Arch Clin Exp Ophthalmol 1999;237:593-600.
• Greenfield DS, Liebmann JM, Jee J, Ritch R. Late-onset bleb leaks after glaucoma filtering surgery. Arch Ophthal- mol 1998;116:443-447.
• Soltau JB, Rothman RF, Budenz DL, et al. Risk factors for glaucoma filtering bleb infections. Arch Ophthalmol 2000;118:338-342.
• Akarsu C., Önol M., Hasanreisoğlu B. İnce tenon ve konjonktivalı olgularda primer trabekülektominin uzun dö- nem sonuçları. Turkiye Klinikleri J Ophthalmol 2003;12:1- 8.