Outcomes of Repeat Trabeculectomy with Mitomycin C for Previous Failed Trabeculectomy

ABSTRACT

PURPOSE: To evaluate the safety and efficacy of repeat trabeculectomy with mitomycin C (MMC) in the management of previous failed trabeculectomy patients. METHODS: We retrospectively reviewed the medical records of 44 eyes of 41 glaucoma patients who had been followed up for at least 6 months after repeat trabeculectomy with MMC and analyzed the success rates according to clinical factors, cumulative success rates, risk factors for surgical failure and complications. Surgical success was defined as an intraocular pressure (IOP) of 21 mmHg or less regardless of glaucoma medications and loss of vision. RESULTS: Postoperative success was obtained in 34 (77.3%) out of 44 eyes after a mean follow-up period of 38.7 months. From Kaplan-Meier survival analysis, cumulative success rates after 6, 12, 24, and 36 months were 97.7%, 89.6%, 83.5%, and 80.1%, respectively. Success rates were significantly lower in eyes with preoperative IOP of 30 mmHg or more. Postoperative complications included transient hypotony in 7 eyes, choroidal detachment in 4, hyphema in 4, and cataract progression in 4. CONCLUSIONS: The success rates of repeat trabeculectomy may be lower than of primary trabeculectomy. However, considering the relatively high success rates and low complications of repeat trabeculectomy with MMC compared to the reported results of glaucoma drainage device implantation, repeat trabeculectomy with MMC is an effective and relatively safe surgical option as the secondary surgical procedure for previously failed trabeculectomy patients.