Mg/ml Mitomycin C Research Articles

One-year Outcomes Following Internal Ligation Suture Removal in 350 mm2 Baerveldt Tube Implant Surgery.

AimLong-term data of the postoperative management following Baerveldt tube surgery (BVT) is currently limited. This study aims to evaluate the outcome and the safety profile of internal ligation suture removal after BVT surgery for refractory glaucoma.Materials and methodsA prospective, consecutive, non-comparative case series of patients previously undergoing BVT 350 mm2 surgery with 0.4 mg/mL mitomycin C (MMC), 3/0 intraluminal suture (Supramid) insertion, and 10/0 nylon external ligation suture(s). For each patient, data was collected over 12 months after internal ligation suture removal. Follow-up assessments looked at intraocular pressure (IOP), complication rate, and postoperative number of glaucoma medications. Definition of success was adopted as per the World Glaucoma Association recommendations.ResultsTwenty-four patients were included. On average, Supramid was removed at 22 ± 18.2 weeks following BVT surgery. Preoperatively, the mean IOP was 30.9 ± 12.6 mm Hg and the average antiglaucoma medications were 1.95 ± 1.13. At 12 months, the mean IOP was 15.2 ± 5.3 mm Hg and the mean number of glaucoma medications was 1.3 ± 0.2. Qualified success with IOP ≤ 21 mm Hg and IOP ≤ 15 mm Hg was achieved in 62.5% and 33.3%, respectively. Only two patients developed hypotony following Supramid removal; both resolved spontaneously within 1 month.ConclusionOur results show a good IOP reduction and safety profile at 1 year from internal ligation suture removal following BVT. A drop in IOP of approximately 50% from the preoperative IOP can be expected.How to cite this articleStringa F, Chen R, Agrawal P. One-year Outcomes Following Internal Ligation Suture Removal in 350 mm2 Baerveldt Tube Implant Surgery. J Curr Glaucoma Pract 2022;16(1):20-23.

The effect of halofugınone and pirfenidone on wound healing in experimental glaucoma filtration surgery

To investigate the effects of halofuginone and pirfenidone on wound healing in experimental glaucoma filtration surgery (GFS). Animal experimentation. A total of 42 male New Zealand albino rabbits were separated into 6 equal groups. A limbal-based trabeculectomy was performed on 5 groups, and Group I (control group) underwent no surgery and received no postoperative medication. For Group II (sham group), 1 drop 0.9% NaCl was instilled qid for 14 days. For Group III, 1% topical corticosteroid (prednisolone acetate) was instilled 1 drop qid for 14 days. For Group IV, 0.4mg/mL mitomycin-C (MMC) was applied intraoperatively to the region of the scleral flap. For Group V, 0.5% pirfenidone was instilled 1 drop qid for 14 days postoperatively. For Group VI, a sponge soaked in 10ng/mL halofuginone was applied to the surgical region for 3 mins. In addition, 1% topical corticosteroid was instilled ×1 drop qid for 14 days postoperatively for Groups IV, V and VI. After 14 days, sections prepared from the bleb regions of the enucleated eyes were evaluated histopathologically and immunohistochemically. Statistical analyses of the study were performed with Kruskal-Wallis variance analysis and the Mann-Whitney U test. With regard to fibroblasts, suppression of the number of mononuclear cells and immunohistochemical staining intensity of transforming growth factor-b (TGF-β), fibroblast growth factor-b (FGF-β) and platelet derived growth factor (PDGF), the corticosteroid, MMC, pirfenidone and halofuginone groups were seen to exhibit more effect than the sham group (P<0.05). Compared to the pirfenidone and fuginone groups, inhibition of fibroblast and monocyte proliferation was determined to be lower in the MMC group (P<0.05). The intensity of TGF-β and FGF-β staining was seen to be lower in these two treatment groups than in the MMC group (P<0.05). Halofuginone and pirfenidone may be used as effective alternative agents in delaying wound healing in glaucoma filtration surgery.

Evaluating the efficacy of short duration Mitomycin C in safe surgery system trabeculectomy combined with cataract surgery.

Purpose: To compare the efficacy of 0.2 mg/ml Mitomycin C (MMC) applied for 1-minute versus 2-minutes in patients undergoing combined surgery for primary glaucoma coexistent with cataract.Materials and methods: This was a randomized controlled clinical trial of 63 patients operated on for primary glaucoma (POAG or PACG) with visually significant cataract. All patients underwent safe surgery system trabeculectomy with manual small incision cataract surgery (MSIC) and implantation of PC IOL. Patients were randomized into intra-operative MMC 0.2 mg/ml for 1-minute (study group) and MMC 0.2 mg/ml for 2-minutes (control group). Success was measured on the basis of two different intraocular pressure (IOP) goals (IOP ≤21 mmHg, IOP ≤18 mmHg) and mean IOP reduction from baseline at the end of 12 months.Results: At 12 months, significant decreases in mean IOP were observed in both groups (P<0.001).The mean IOP reduction was 31.33±9.06% in the study group, as compared to 43.32±9.38% in the control group (P<0.001). The overall success for IOP ≤21 mm Hg was 80.5% in the study group and 90.9% in the control group (P<0.05). Kaplan-Meier analysis showed an insignificant difference in overall success rates of the two groups.Conclusion: The IOP reduction with 2-minute MMC (0.2 mg/ml) is more effective than 1-minute MMC after 12 months. It offers a decrease in anti-glaucoma medications and substantial visual recovery in combined surgery done for primary glaucoma coexistent with cataract.

Modulating Ocular Scarring in Glaucoma Filtration Surgery Using the Epigenetic Adjunct Suberoylanilide Hydroxamic Acid.

ABSTRACTAimThe aim of this study is to assess the effectiveness of suberoylanilide hydroxamic acid (SAHA), a histone deacetylase inhibitor (HDI) with a broad spectrum epigenetic activity, in improving filtration bleb survival as an adjunct therapy to glaucoma filtration surgery (GFS) in the rabbit model.Materials and methodsEighteen New Zealand White rabbits underwent GFS in the left eye and were randomized to receive either a subconjunctival (SC) injection of 0.1 mL SAHA (9.25 μg/mL) or balanced saline solution (BSS) at the end of surgery, or a 3-minute intraoperative topical application of 0.4 mg/mL mitomycin-C (MMC). Bleb survival and histology were compared.ResultsBlebs of rabbits receiving injections of SAHA survived an average (mean ± SD) of 23.2 ± 2.7 days. SAHA rabbits showed a nonsignificant improvement over rabbits that received an injection of BSS, which had a mean survival time of 19.7 ± 2.7 days (p = 0.38) according to a one-way analysis of variance (ANOVA). Eyes receiving intraoperative topical MMC survived an average of 32.5 ± 3.3 days, which is significantly longer than both the control group treated with BSS (p = 0.01) and the experimental group treated with the SAHA (p = 0.0495). SAHA was well tolerated and showed no significant avascularity, necrosis, or conjunctival thinning.ConclusionAlthough it was well tolerated, a single intraoperative injection of SAHA did not significantly prolong bleb survival in the rabbit model.Clinical significanceEpigenetic adjuncts hold promise for improving GFS outcome; however, future studies must continue to examine different administration protocols and dosages to substantiate their efficacy.How to cite this articleRodgers CD, Lukowski ZL, et al. Modulating Ocular Scarring in Glaucoma Filtration Surgery Using the Epigenetic Adjunct Suberoylanilide Hydroxamic Acid. J Curr Glaucoma Pract 2019;13(1):37–41.

Treatment of ocular surface squamous neoplasia: Case reportof ocular surface squamous neoplasia: Case report

Aim: Ocular surface squamous neoplasia (OSSN) is a term that encompasses a wide and varied spectrum of very rare dysplastic disease of cornea and conjunctiva, ranging from conjunctival intraepithelial neoplasia (CIN), carcinoma in situ (CIS) to invasive squamous cell carcinoma (SCC) of conjunctiva and/or cornea. Case report: In our case report, we present squamous cell carcinoma of the conjunctiva and cornea in a 78-year old man. Our diagnostic algorithm included: slit lamp and fundus examination, gonioscopy, impression cytology (IC) andmagnetic resonance imaging (MRI). The patient underwentsurgical excisional biopsy of the lesion and intraoperativecryotherapy of the cut conjunctival edges and sclera-conjuctiva base region. Following surgical therapy, we started topical 0.02 % (0.2 mg/ml) Mitomycin C (MMC) application daily for 14 days. Control excisional biopsy of conjunctival edge and abrasion of involved cornea were performed following the last day of topical chemotherapy. Our controlexcisional biopsyrevealed tumor positive corneal tissue and the second cycle of topical 0.04 % (0.4 mg/ml) MMCchemotherapy wasstarted for next 3 weeks. The patient has been followed-up for 20 months through monthly–based visits, with no recurrence of the disease. Conclusions: OSSN is a surgical challenge requiring a specialized ‘no-touch’ (NT) technique. In our case, the combination of surgical excision with intraoperative cryotherapy and topical chemotherapy with 0.02 % MMC application for 14 days, completed with second cycle of topical 0.04 % MMC drops for the next 21 days given the positive control biopsy, proved to be a good choice for eradication of OSSN with accurate further monitoring of the patient.

Combined trabeculotomy-trabeculectomy with antimetabolite and releasable suture: outcome with primary congenital glaucoma in a north Indian population.

To determine the surgical outcomes of combined trabeculotomy- trabeculectomy with mitomycin-C and releasable suture in children with primary congenital glaucoma (PCG) in a North Indian population. Retrospective, interventional, consecutive, non-comparative case series. The medical records of 137 eyes of 77 patients who underwent combined trabeculotomy- trabeculectomy with 0.2 mg/ml mitomycin C (MMC) either bilaterally (49 patients) or unilaterally (28 patients) between January 2004 and March 2012 were reviewed retrospectively. The main outcome measures were postoperative intraocular pressures, corneal clarity and diameter, duration of follow-up, success rate and complications. The mean preoperative intraocular pressure reduced from 34 ± 7 mm Hg (range 15- 54 mm Hg) to 17 ± 7 mm Hg (range 5 - 32 mm Hg) with a mean reduction of 44 % (P less than 0.001). The mean follow-up period was 24.4 ± 10.3 months (range 6 - 48 months). Complete success defined as intraocular pressure less than 21 mm Hg without any medication and clinically stable glaucoma at last follow-up was achieved in 113 eyes (83 %) while a 'qualified success' of intraocular pressure less than 21 mm Hg with one medication was achieved in ten eyes (7 %). The Kaplan-Meier survival analysis revealed success rates (at 'n' months) of 90 % (6), 85 % (12), 82 % (24), 80 % (36) and 77 % (48). There were no significant intraoperative or postoperative complications. Primary combined trabeculotomy-trabeculectomy with mitomycin-C and releasable suture offers a viable surgical option in Northern Indian infants with primary congenital glaucoma. The use of 0.2 mg/ml mitomycin C for 2 minutes improves the overall success while the releasable suture decreases the risk of postoperative complications especially associated with the use of antimetabolites.

Intravitreal ranibizumab as adjuvant treatment for neovascular glaucoma

The purpose of this study was to describe a prospective case series of 5 eyes treated with intravitreal ranibizumab injection for neovascular glaucoma (NVG). Five patients with clinically uncontrolled NVG secondary to proliferative diabetic retinopathy (4 patients) and central retinal vein occlusion (1 patient), non-responsive to maximal tolerable medication and panretinal photocoagulation, received intravitreal ranibizumab injection (0.5 mg). Patients were seen at 1st, 3rd and 7th day after the ranibizumab injection and when it was necessary. Success was defined as intraocular pressure (IOP) 21, despite maximal tolerable medication, underwent trabeculectomy with 0.5mg/ml mitomycin C (MMC) for 1 minute. Failure was defined as IOP > 21 mmHg, phthisis bulbi, loss of light perception or additional glaucoma surgery. The primary outcome was 6-month IOP control. Mean IOP before the ranibizumab injection was 37 mmHg (7 mmHg SD). Two out of five eyes underwent only ranibizumab injection, having an IOP control after the procedure. Three patients were submitted to trabeculectomy with MMC on the 7th day after the injection. At 6-month follow-up, the mean IOP was 12mmHg (3 mmHg SD). All eyes showed regression of rubeosis iridis and IOP control. Visual acuity improved in 2 eyes worsened in 1 eye, and remained stable in 2 eyes. These data suggest that intravitreal ranibizumab injection may be a useful tool in the treatment of NVG.

Results of Trabeculectomy Using Modified Scleral Flap Suture Technique in Comparison with Standard Trabeculectomy

Purpose: To evaluate the efficacy of trabeculectomy using modified scleral flap suture technique Methods: We retrospectively reviewed the medical records of 52 patients (55 eyes) who had undergone trabeculectomy from January 2003 to January 2007. Standard trabeculectomy was performed for 29 eyes of 27 patients, modified trabeculectomy for 26 eyes of 25 patients. We changed suture site of scleral flap corner about 1mm medially from original site and added tight suture to both lateral margins of scleral flap to prevent overflow in modified group. In both groups, most of patients were injected 0.1 ml of 0.02 mg/ml mitomycin-C (MMC) subconjunctivally and the others 0.1 ml of 0.04 mg/ml MMC. We evaluated intraocular pressure (IOP), complication, morphology of filtering bleb, cumulative success rates. Results: Argon laser suturelysis was performed postoperatively in about half cases of both groups. The IOPs of modified group were consistently lower than those of standard group for 24 months except postoperative 1 day and 1 week. There was a significant difference of IOP at postoperative 2 months and 12 months (p