Abstract
AimTo determine the safety and efficacy of intraoperative injection of mitomycin C (MMC) against conventional sponge-applied MMC during trabeculectomy.Materials and methodsThis study was a retrospective, comparative case series. Thirty eyes with primary open-angle glaucoma underwent consecutive trabeculectomies with MMC injection (injection group), and thirty eyes with sponge-applied MMC were as controls (sponge group). Data were collected preoperatively and postoperatively at 1 day, 1 week, 1 month, 3 months, 6 months, and 1 year after surgery. Demographic data, applanation intraocular pressure (IOP), best-corrected visual acuity (VA), number of glaucoma medications, postoperative interventions, postoperative complications, and number of visits within 3 months were recorded. In order to stratify data, proportion of eyes achieving >30% IOP reduction from baseline with or without glaucoma medications was calculated and defined as surgical success.ResultsMean IOP reduction at 1 year was significant in both the injection and sponge groups from baseline (46.8 and 37.8% respectively). The injection group had overall lower postoperative IOP and comparable complete treatment success, defined as achieving >30% IOP reduction without glaucoma medications (p = 0.941). The number of postoperative visits within 3 months and the proportion of eyes needing 5-fluorouracil (5-FU) intervention were significantly lower in the injection group (p = 0.03, p = 0.04 respectively).ConclusionInjection of MMC was as safe and effective as sponge application with comparable estimated complete treatment success, less need for visits within 3 months, and 5-FU intervention.Clinical significanceSurgeons may consider intraopera-tive injection of MMC in appropriate patient cohorts given comparable safety and efficacy and several advantages over traditional sponge application. Further study in a prospective, larger, long-term manner is necessary to assess this modality.How to cite this article: Khouri AS, Huang G, Huang LY. Intraoperative Injection vs Sponge-applied Mitomycin C during Trabeculectomy: One-year Study. J Curr Glaucoma Pract 2017;11(3):101-106.
Highlights
Mitomycin C is an antineoplastic/antibiotic agent isolated from soil bacterium Streptomyces caespitosus
The use of MMC in trabeculectomy is indicated in patients who are young, African-American, or have had previous surgery, and has been shown to increase fibroblast density and compact connective tissue over time.[5]
There were no differences in baseline intraocular pressure (IOP), visual acuity (VA), age, or number of glaucoma medications between groups (p > 0.05)
Summary
Mitomycin C is an antineoplastic/antibiotic agent isolated from soil bacterium Streptomyces caespitosus It acts as a deoxyribonucleic acid cross-linker, which inhibits fibroblast proliferation. For more than two decades, MMC has been routinely used during trabeculectomy to reduce postoperative episcleral fibrosis and bleb failure due to scarring by the wound healing process.[3] It was found to be effective in inhibiting fibroblastic activity, and its use has tremendously impacted the success rates of trabeculectomy.[4] The use of MMC in trabeculectomy is indicated in patients who are young, African-American, or have had previous surgery, and has been shown to increase fibroblast density and compact connective tissue over time.[5] Studies have shown that the use of MMC improves outcomes in glaucoma filtration surgery with good long-term IOP control.[6,7,8] Traditionally, MMC is applied by being soaked onto a surgical sponge and placed onto the scleral surgical site prior to creation of the ostomy, before or after formation of a partial thickness scleral flap. The sponge is removed after a variable amount of time depending on the surgeon’s preference, ranging from 30 seconds to 5 minutes.[9]
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