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

Ophthalmology. 2002 Jul;109(7):1336-41; discussion 1341-2. doi: 10.1016/s0161-6420(02)01069-2.


Purpose: To examine the 5-year complications and results of primary trabeculectomy with mitomycin-C (MMC).

Design: Retrospective, noncomparative interventional case series.

Participants: One hundred twenty-three eyes that underwent primary trabeculectomy with MMC between December 1991 and March 1995.

Methods: 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.

Main outcome measures: The incidence of complications, including hypotony with or without maculopathy, bleb leak or blebitis, pressure control, and medication reduction at yearly intervals.

Results: 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).

Conclusions: Primary mitomycin trabeculectomy significantly lowers IOP at 5 years but is associated with a high incidence of delayed hypotony.

MeSH terms

  • Antibiotics, Antineoplastic / therapeutic use*
  • Combined Modality Therapy
  • Female
  • Follow-Up Studies
  • Glaucoma, Angle-Closure / drug therapy
  • Glaucoma, Angle-Closure / surgery*
  • Glaucoma, Open-Angle / drug therapy
  • Glaucoma, Open-Angle / surgery*
  • Humans
  • Intraocular Pressure
  • Male
  • Mitomycin / therapeutic use*
  • Postoperative Complications
  • Retrospective Studies
  • Safety
  • Sclera / drug effects*
  • Time Factors
  • Trabeculectomy / methods*
  • Treatment Outcome


  • Antibiotics, Antineoplastic
  • Mitomycin