Efficacy and safety of mitomycin C--augmented revisions of non-functioning filtering blebs after trabeculectomy--7 year results.

PURPOSE: To determine the efficacy and safety of mitomycin C-augmented revision in eyes after failed primary trabeculectomy failure. MATERIAL AND METHODS: Retrospective review of 40 eyes after a single MMC-augmented revision due to primary trabeculectomy failure. MAIN OUTCOME MEASURES: intraocular pressure, best corrected visual acuity, number of antiglaucoma medications, complications. RESULTS: Twelve months after revision the mean intraocular pressure declined from 24.5 +/- 6.7 mmHg to 15.4 +/- 4.4 mmHg (p < 0.05) and remained decreased at 24 months (16.33 +/- 4.2 mmHg) and at 84 months (16.75 +/- 2.8 mmHg). The therapeutic success, defined as intraocular pressure < or = 18 mmHg without medication at 12 months after revision, was achieved in seventeen eyes (42.5%). Fourteen eyes (35.0%) achieved qualified success, defined as intraocular pressure < or = 18 mmHg with antiglaucoma medication, and 9 of 40 eyes (22.5%) were classified as failures. Mean best corrected visual acuity did not change significantly after the surgery (12 month: p = 0.76, 36-48 months: p = 0.25, 72-84 months: p = 0.15). The mean number of medications was reduced from 1.2 +/- 0.8 preoperatively to 0.68 +/- 0.8 postoperatively at 12 months, to 0.78 +/- 0.49 at 24 months and the drop was statistically significantly. Early complications developed in 7 (17.5%) eyes but they resolved spontaneously. CONCLUSIONS: MMC-augmented revision appears to be a safe and useful tool in reducing intraocular pressure after trabeculectomy failure. This simple-technique procedure is successful in 42.5% of eyes for up to 24-36 months and helps protect the eye from other surgical intervention, more destructive for the conjunctiva.