Trabeculectomy at the inferior limbus

Objective: To evaluate intraocular pressure (IOP) control and surgical complications following trabeculectomy with 5-fluorouracil (5-FU) or mitomycin at the inferior limbus. Methods: The charts of all patients undergoing trabeculectomy at the inferior limbus from July 1984 to March 1993 were reviewed. Surgical success was defined as IOP greater than 4 mm Hg and less than 22 mm Hg and at least a 20% reduction from preoperative IOP. Patients: All 101 eyes of 101 patients had undergone prior intraocular surgery at the superior limbus. Mean patient age was 57.5+/-2.0 (+/-SE) years; mean follow-up was 23.4+/-2.3 months; mean preoperative IOP was 32.8+/-0.9 mm Hg; and mean number of preoperative antiglaucoma medications was 2.8+/-0.1. Results: Ninety-four eyes (93.1%) received postoperative 5-FU (mean total dose, 36.3 +/- 1.7 mg) and seven eyes (6.9%) received intraoperative mitomycin (0.5 mg/ mL). Cumulative success for all eyes at 2 and 5 years was 56% and 38%, respectively. Intraocular pressure control without medications was achieved in 39% and 15% of eyes at 2 and 5 years, respectively. Complications included 5-FU epitheliopathy (34.0% of eyes receiving 5-FU), early wound leak (26.7%), choroidal effusion (25.7%), late bleb leak (12.9%), and late bleb-related endophthalmitis (11.9%). Conclusion: Although trabeculectomy at the inferior Limbus offers the opportunity for surgical success in eyes at high risk of failure, this procedure carries an-increased risk for late complications and should be reserved for cases in which the therapeutic options are extremely Limited.