**Trabeculotomy Augmented by Postoperative Topical Medications vs. Trabeculectomy Augmented by Mitomycin C**

Hiroshi Kobayashi

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/60089

#### **Abstract**

**Purpose:** To study the safety and hypotensive effect of trabeculotomy augmented by postoperative topical medical treatment in patients with open-angle glaucoma and to compare with trabeculectomy augmented by mitomycin C.

**Methods:** Inanon-randomized consecutive case series, we studied 82 patients with open-angle glaucoma who underwent trabeculotomyaugmented by postoperative medical therapy or trabeculectomy augmented with Mitomycin C. Forty-two pa‐ tients underwent trabeculotomyfollowed by latanoprost 0.004%, timololmaleate XE 0.5% and brinzolamide 1% and 40 patients underwent trabeculectomy augmented with Mitomycin C. Patients were followed-up for 12 months and a success rate based on intraocular pressure was compared.

**Results:** Mean baseline intraocular pressure was27.9 ± 5.4 mmHg in the trabeculoto‐ my group and 28.3 ± 4.2 mmHg in the trabeculectomy group (P = 0.7). Mean postop‐ erative intraocular pressure was 15.1 ± 2.1 mmHg at 3 months, 14.7 ± 2.1 mmHg at 6 months, and 14.9 ± 2.0 mmHg at 12 months in the trabeculotomy group and 12.2 ± 1.9 mmHg at 3 months, 12.8 ± 3.0 mmHg at 6 months, and 13.9 ± 4.2mmHg at 12 months in the trabeculectomy group.Mean intraocular pressure in the trabeculoto‐ mygroup was significantly higher than that in the trabeculectomy group at 3 and 6 months (P < 0.0001 at 3 months; P = 0.0005 at 6 months) and there was no significant difference between the two groups at 12 months (P = 0.1). At 12 months, 42 patients (100%) in the trrabeculotomy group and 37 patients (92.5 %) in the traberculectomy group achieved an intraocular pressure of less than or equal to 20 mmHg and a minimum of 30 percent reduction (P = 0.1). In the trabeculectomy group, 15 patients

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(37.5 %) received laser suture lysis,6 patients (15.0 %) underwent needling proce‐ dure, and 3 patients (7.5 %) underwent additional surgery, although no patient in the trabeculotomy group received postoperative intervention except for topical medical treatment. In the trabeculotomy group, patients with higher preoperative intraocular pressure showed a significantly higher intraocular pressure at 12 months postoperatively (P < 0.0001), although there was no significant correlation between them in the trabeculectomy group.

**Conclusions:** There was no significant difference in hypotensive efficacy between patients undergoing trabeculotomyaugmented by postoperative topical medica‐ tions and those undergoing trabeculectomyaugmented by Mitomycin Cat 12 months. In those receiving trabeculotomy, patients with higher preoperative intra‐ ocular pressure showed a significantly higher intraocular pressure at 12 months even though less than 20 mmHg.

**Keywords:** trabeculotomy, trabeculectomy, postoperative medication

#### **1. Introduction**

Trabeculectomy has been a standard procedure for medically uncontrollable glaucoma [1]. Serious postoperative complications are not infrequently associated with trabeculectomy [2-5]. These include flat anterior chamber, hypotony and choroidal detachment caused by overfil‐ tration, late-onset bleb-related complications, including endophthalmitis, and cataract progression. Shigeeda et al. demonstrated that 44.5% of patients who had undergone trabe‐ culectomy augmented with mitomycin C showed a success defined as an intraocular pressure of less than 16 mm Hg after 8 years [6]. However, Tanihara et al. demonstrated that medical treatment following trabeculotomy provided an additional intraocular pressure reduction and that this surgery produced long-term stability of intraocular pressure control [7]. Trabeculot‐ omy infrequently causes serious complications and seldom requires additional postoperative interventions [8, 9]. The aim of this study is to study the safety and hypotensive effect of trabeculotomy augmented by postoperative medical treatment in patients with open-angle glaucoma and to compare with trabeculectomy augmented by mitomycin C.

#### **2. Patients and methods**

In a non-randomized consecutive case series, we studied 82 patients with open-angle glaucoma who underwent trabeculotomy augmented by postoperative medical therapy or trabeculec‐ tomy augmented with mitomycin C. A diagnosis of glaucoma was on the gonioscopic finding along with appearance of the optic nerve head cupping and visual alteration according to the guideline of Japan Glaucoma Society [10]. Excluded were patients with angle-closure glauco‐ ma or posttraumatic, uveitic, neovascular, or dysgenetic glaucoma, as well as patients undergoing previous ocular surgery. Before March, 2010, all patients underwent trabeculec‐ tomy augmented with mitomycin C, and after April, 2010, all patients underwent trabeculot‐ omy followed by latanoprost 0.004% (Xalatan™, Pfizer, New York, NY, USA), timolol maleate XE 0.5% (Timoptol XE 0.5%™, Santen, Osaka, Japan), and brinzolamide 1% (Azopt™, Alcon, Fort Worth, TX, USA). Patients were followed up for 12 months and the success rate based on intraocular pressure was compared. The study protocol and consent forms were approved by the Human Subjects Committee. When both eyes were eligible, the right eye became the study eye.
