Læknablaðið - 15.06.1997, Blaðsíða 76

428
LÆKNABLAÐIÐ 1997; 83
University of Glasgow, Church Street, Glasgow
Gll 6NT, Scotland
Introduction: Trabeculectomy enhanced with
Mitomycin-C (MMC) has been shown to be effec-
tive in eyes with poor prognosis.Reports in litera-
ture have indicated that MMC trabeculectomy is
a more hazardous procedure associated with high
rates of hypotony and associated permanent re-
duction in vision. Whilst noting the procedure’s
efficacy, we had not felt that the operation pro-
duced problems any greater than those experi-
enced in the highly successful use of trabeculecto-
my for routine glaucoma cases. We therefore de-
cided to compare our results and complication
rates of MMC enhanced trabeculectomies in pa-
tients with the ’poorest prognosis’, with the
known highly successful first trabeculectomies
without MMC in patients with primary open an-
gle glaucoma.
Material and methods: Thirty six ’worst case’
patients who had undergone surgery with full dos-
es of MMC were compared retrospectively with
43 contemporary ‘best prognosis’ controls. An
expanded analysis of 59 MMC trabeculectomies
was used to study the adverse effects of MMC.
Our ’worst case’ patients included those with pre-
vious failed drainage surgery, developmental
glaucoma as in aniridia and iridocorneal endo-
thelial syndrome, secondary glaucoma as in uvei-
tis and rubeosis, aphakic glaucoma and glaucoma
following complicated extracapsular lens extrac-
tion with vitreous entry into the anterior cham-
ber. Thirteen procedures were performed with
MMC for one of the four cardinal indications
(repeat operation; developmental/aniridia/ICE
glaucoma; uveitic/neovascular; or aphakic glau-
coma). Nineteen MMC cases had two of the in-
dications and four had three.
Results: The two groups were similar in their
intraocular pressure profile, change in visual
acuity and visual field scores. The absence of
serious complications was noted in both the
groups. The follow-up ranged from 0 to 48
months, with a mean of 30.2 months for the MMC
group and 32.8 months for the controls. Three
MMC trabeculectomies had intraocular pressures
of less than 6 mm of Hg and only one of them
developed hypotony maculopathy.
Discussion: Our study indicates that adjunctive
use of MMC in trabeculectomies with an adverse
surgical prognosis achieves the same profile of
benefit and risk as trabeculectomy in optimum
cases. MMC used in trabeculectomies with a poor
prognosis has a good end result as opposed to
MMC used in good prognosis routine trabeculec-
tomies. MMC in the absence of poor prognostic
factors often results in hypotony and a poor re-
sult. Our paper lists appropriate indications for
use of MMC in trabeculectomy.
A-7. Glaucoma epidemiology in Iceland.
The Reykjavík Eye Study
Friðbert Jónassoit*, Sasaki K**, Þórður Sverris-
son*, Einar Stefánsson*, Vésteinn Jónsson*,
Gyða Bjarnadóttir*, Ársœll Arnarson*, Kojima
M**, Sasaki H**, Kasuga T** and the Iceland-
Japan co-working Study Groups
From The *Department of Ophthalmology, Uni-
versity oflceland, Reykjavík, Iceland, The **Uni-
versity Department of Ophthalmology, Kanasawa
Medical University, Kanasawa, Japan
Introduction: The purpose of the study is to
establish the prevalence, age and sex distribution
of primary open angle glaucoma (POAG) and its
relation to pseudoexfoliation (PEX), as well as
establish the usefulness of an image analysis sys-
tem (EAS 1000, Nidek) in glaucoma epidemi-
ological studies.
Material and methods: Seventeen hundred Ice-
landers >50 years old living in Reykjavík were
sampled by randomisation. All persons in the
study had visual acuity tested, IOP and slitlamp
examination and stereo fundusphotography.
POAG was determined as follows: all participa-
nts with previous history of glaucoma had addi-
tional visual field testing and persons with IOP
>23 Torr and/or cup/disc ratio >0.8 or difference
between eyes of >0.3 were also specially exam-
ined for glaucoma. On the EAS 1000 equipment
the anterior chamber depth and angle width were
measured.
Results: One thousand forty five persons elect-
ed to participate in the study, representing 66.5%
of persons 50-79 years old and 33% of persons
>80 years old. Two persons had narrow angle
glaucoma. Twenty one females and 23 males had
POAG. In the age group 50-59 years, 60-69
years, 70-79 years and >80 years the prevalence
of POAG was 0.8%, 3.3%, 8.0% and 11.5% re-
spectively, the same figures for definite PEX be-
ing 1.9%, 6.4%, 11.0% and 19.9%. Of the pa-
tients with POAG 60.5% had visual field defects.
Pseudophakia was rare in the age groups 50-69
years. In the age group 70-79 year however 30%
of the glaucoma patients were pseudophakic
compared with 9.5% in the remainder of the same
age group, the corresponding figures for >80
years being 66.6% and 28.9% respectively.
POAG therefore carries a greatly increased risk
of visually disabling cataract. Of eyes with defi-