Efficacy and safety of mitomycin-C in primary trabeculectomy: five-year follow-up

To examine the 5-year complications and results of primary trabeculectomy with mitomycin-C (MMC). Retrospective, noncomparative interventional case series. One hundred twenty-three eyes that underwent primary trabeculectomy with MMC between December 1991 and March 1995. All patients received standard trabeculectomy performed by one of two surgeons, using a Weck cell-soaked pledget of MMC, 0.25, 0.33, or 0.5 mg/ml, for 0.5 to 5 minutes. Laser suture lysis was performed postoperatively for intraocular pressure control. The incidence of complications, including hypotony with or without maculopathy, bleb leak or blebitis, pressure control, and medication reduction at yearly intervals. Mean preoperative and year 5 postoperative intraocular pressures (IOP) were 25.79 and 9.91 mmHg ( P < 0.05, paired t test). Hypotony (IOP < 6) occurred in 42.2% of eyes after a mean follow-up of 26.1 months. Hypotony maculopathy occurred in 8.9% of eyes at mean follow-up of 33.7 months. Bleb leak occurred in 14.6% of eyes at a mean follow-up of 27.9 months. Blebitis occurred in 5.7% of eyes at a mean follow-up of 35.4 months, and endophthalmitis occurred in 0.8% of eyes at 15 months; 14.9% of eyes lost 4 lines of visual acuity. The single predictor for the development of late-term hypotony was IOP 1 month after operation ( P < 0.05). Primary mitomycin trabeculectomy significantly lowers IOP at 5 years but is associated with a high incidence of delayed hypotony.