Mitomycin-C trabeculectomy versus Ahmed glaucoma implant in pediatric aphakic glaucoma

Purpose: To compare the outcomes and complications of mitomycin-C trabeculectomy (MMC-T) versus the Ahmed glaucoma implant (AGI) for treatment of pediatric aphakic glaucoma. Methods: In a randomized clinical trial, 30 eyes of 28 children <16 years of age who had undergone anterior lensectomy-vitrectomy for congenital cataract were assigned to MMC-T (15 eyes of 13 children) or AGI (15 eyes of 15 children). Surgical success was classified as complete (IOP 6-21 mmHg without any antiglaucoma medication) and partial (IOP 6-21 mmHg with ≤2 topical antiglaucoma agents) in the absence of any sight-threatening complication or need for further glaucoma surgery, stable cup/disc ratios and visual loss ≤2 Snellen lines. Overall success was defined as the sum of complete and partial success. Results: Mean patient age was 9.1±4.1 and 10.9±5.1 years in the MMC-T and AGI groups, respectively (P=0.29). After a mean follow up of 14.8±11 and 13.1±9.7 months; complete, partial and overall success rates were 33.3%, 40% and 73.3% in the MMC-T vs 20%, 66.7% and 86.7% in the AGI groups, respectively (P= 0.361). Complication and failure rates were 40% and 26.7% in the MMC-T group vs 26.7% and 13.3% in the AGI group, respectively (P= 0.439). Conclusion: MMC-T and AGI seem to be comparable in terms of success and complications as the initial surgical procedure in pediatric aphakic glaucoma. Choice of either technique depends on surgeon's experience and conjunctival quality and mobility.