Abstract
Purpose:To evaluate the effect of mitomycin-C (MMC) on corneal endothelial cell density (ECD) and morphology after trabeculectomy.Methods:In this prospective comparative case series, 31 eyes with glaucoma underwent trabeculectomy with (group I), or without (group II) MMC. Specular microscopy was performed pre-, and postoperatively at months 1 and 3. Outcome measures included central corneal endothelial cell count and coefficient of variation (CV) of cell size.Results:Overall, mean preoperative ECD was 2,135.8 ± 397.6 cells/mm2; corresponding values at postoperative months 1 and 3 were 2,019.6 ± 447.2 cells/mm2, and 1,991.4 ± 425.5 cells/mm2, respectively (P > 0.05). Cell loss from month 1 to 3 was 1.3 % (P > 0.05). Subgroup analysis showed significant differences in endothelial cell loss at month 1 (P = 0.048) and month 3 (P = 0.014) between the MMC and control groups with no significant difference between the two groups in terms of cell loss from months 1 to 3, postoperatively (P = 0.968). Overall, mean pre-and postoperative CVs at months 1 and 3 were 27.38 ± 4.55, 27.96 ± 4.26, and 28.35 ± 4.47, respectively, with no significant difference between the two groups (P > 0.05). There was no correlation between preoperative central endothelial cell density (CECD) and MMC related cell loss.Conclusion:MMC application in trabeculectomy seems to cause a small but significant corneal endothelial loss. Most of the damage occurs intraoperatively, or in the early postoperative period, however progressive endothelial cell loss is not a major concern.
Highlights
There were no significant differences in terms of type of glaucoma, mean age, mean IOP, gender and preoperative specular microscopic findings between the two groups (P > 0.05)
endothelial cell density (ECD) is widely used as a parameter of corneal endothelial health, it does not reflect the dynamics of endothelial healing that occur following trauma
The early response to endothelial cell loss consists of enlarging and sliding of the remaining cells leading to increased coefficient of variation (CV) and a decrease in hexagonality
Summary
Adjunctive antifibrotic agents, such as 5-fluorouracil (5-FU) or mitomycin-C (MMC), are commonly used to increase the success rate of glaucoma filteringReceived: 13-04-2014Accepted: 28-10-2014Access this article onlineQuick Response Code: Website: www.jovr.orgDOI: 10.4103/2008-322X.170345 surgery.[1,2] Due to the greater potency and fewer complications, MMC is currently in widespread use in trabeculectomy.[3,4] MMC is an antibiotic derived from Streptomyces caespitosus with alkylating properties that exerts its most profound cellular toxicity in the late G1 and early S cellular phases.[5] It is suggested that in high doses, MMC has a cytotoxic effect that is independent of cell cycle.[6] Moreover, it is described as a radiomimetic agent with possible long-term consequences on tissues.[7] In trabeculectomy, MMC may penetrate into adjacent
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