[Long-term follow-up study on Hunan aqueous drainage implantation combined with mitomycin C for refractory glaucoma]

Abstract

Purpose: To investigate the long-term therapeutic effect of Hunan aqueous drainage (HAD) implantation with and without adjunctive intraoperative mitomycin C (MMC) for refractory glaucoma.

Methods: 154 cases (159 eyes) with refractory glaucoma underwent Hunan aqueous drainage (HAD) implantation from July 1995 to July 2001. Sixty-five eyes were combined with MMC (0.4 mg/ml, 1 to 5 mins). With success defined as the introcular pressure (IOP) greater than 6 mmHg but no greater than 21 mmHg at the last visit.

Results: The mean period of postoperative follow-up was 54.6 (range, 12-72) months. The IOP was lowered from preoperative (46.8 +/- 14.5) mmHg to postoperative (16.8 +/- 11.3) mmHg at the 1st year after surgery. The success rate with MMC and without MMC were 90.0%, 77.3% (P < 0.05) at the 1st year, 87.1%, 67.3% (P < 0.05) at the 2nd year, 83.3%, 61.1% (P < 0.05) at the 3rd year, 81.3%, 56.7% (P < 0.05) at the 4th year, and 75.0%, 50.0% (P < 0.05) at the 5th year using Kaplan-Meier life-table analysis. The height of the posterior bleb underwent standardized ocular echography at the 1st year was (3.8 +/- 0.9) mm and (2.1 +/- 1.4) mm, respectively. Ninty-five eyes (81.9%) with visual acuity remained or improved after the surgery (P > 0.05). The most frequent complications for long-term follow-up included elevated IOP (IOP > 22 mmHg) (19.8%), the iris adherent to the proximal orifice of the tube (15.5%), developed cataract formation (12.9%) and so on (P > 0.05). We didn't find any severe complications after using MMC.

Conclusion: This study suggests that HAD implantation is an effective method in the management of refractory glaucoma in spite of its unneligible complications and combined with MMC can improve the prognosis.