The risk profile of mitomycin C in glaucoma surgery

Abstract

Since the introduction of mitomycin C (MMC) into the ophthalmic world, the highly successful intraocular pressure control achieved by the intraoperative use of MMC adjunctive to trabeculectomy (MMC trabeculectomy) drew the attention of many ophthalmologists. The drug has a toxic effect on healthy cells in nature and some complications related to it have already been reported. We review some of the MMC-related complications in the literature in addition to our clinical experience. Corneal toxicity is mild in a clinical setting but may be severe if the drug enters the anterior chamber or remains on the ocular surface for a longer period. Experience obtained in pterygium surgery suggests that the least dosage should be used to avoid scleral complications, although they have not been reported after glaucoma surgery as yet. Hypotonous maculopathy is a vision-threatening complication of MMC trabeculectomy and some patients require some measures taken to increase intraocular pressure. Cataract and some early postoperative complications such as shallow anterior chamber develop at a similar rate to that after conventional trabeculectomy without antiproliferative agents. Proper surgical techniques in addition to careful follow-up early in the postoperative period make the best of MMC as an adjunct to trabeculectomy.