Mitomycin-C Trabeculectomy versus Ahmed Glaucoma Implant for Treatment of Pediatric Aphakic Glaucoma

To compare the outcomes and complications of mitomycin-C (MMC) trabeculectomy and Ahmed glaucoma implant (AGI) for treatment of aphakic glaucoma following congenital cataract surgery in children  16 years of age. In a randomized clinical trial, eligible children were randomly assigned to MMC trabeculectomy or AGI. Aphakia was due to previous anterior lensectomy and vitrectomy. Cases were excluded if cataract was due to persistent hyperplastic primary vitreous or intrauterine infections or if the patient had previous ocular surgery other than anterior lensectomy and vitrectomy. Fifteen eyes of 13 children with mean age of 9.1  4.1 year underwent MMC trabeculectomy and 15 eyes of 15 children with mean age of 10.95.1 year were treated with AGI. Results of surgery were classified as complete success (5 < IOP < 21 mmHg without any antiglaucoma medication) and partial success (IOP < 21 mmHg with a maximum of two topical antiglaucoma agents) in the absence of any sight-threatening complication or further glaucoma surgery, stable cup/disc ratio and vision loss not greater than two Snellen lines; otherwise the surgery was considered as failed. The sum of complete and partial success was considered as overall success. Data was analyzed by SPSS software version 13 using T-test, Pearson Chi-square, and paired T-test. Mean follow-up period was 14.811 months in the MMC trabeculectomy group and 13.19.7 months in the AGI group. Complete, partial and overall success rates were 33.3%, 40%, and 73.3% in the MMC trabeculectomy group and 20%, 66.7%, and 86.7% in the AGI group, respectively. (P= 0.361) Complication rates were 40% in the MMC trabeculectomy group and 26.7% in the AGI group. (P = 0.439) The most frequent complication was choroidal effusion in both groups. The most common cause of failure was flat vascularized nonfunctional bleb in the trabeculectomy group and suprachoroidal hemorrhage in the AGI group. This study revealed that MMC trabeculectomy and AGI achieve comparable results in terms of success and complications in pediatric aphakic glaucoma with no previous glaucoma procedure. Selection between these two surgical procedures depends on surgeon's experience in addition to conjunctival quality and mobility.