Mitomycin C Group Research Articles

The effect of thermochemotherapy with mitomycin C on normal bladder urothelium, an experimental study.

To investigate the effects of thermochemotherapy with mitomycin C (MMC) on normal rabbit bladder urothelium and to compare it with standard intravesical MMC and hyperthermia with normal saline. Twenty-four male New Zealand rabbits, with a mean weight of 2.7 kg (in weight of 2.1–4.3 kg), were divided into three groups, each containing eight rabbits. Thermotherapy with only normal saline was performed in the first group, standard intravesical MMC was performed in the second group, and thermotherapy with MMC was performed in the last group. A week after the primary procedure, total cystectomy was performed and tissue samples were evaluated. The presence of epithelial vacuolar degeneration (p = 0.001), epithelial hyperplasia (p = 0.000), subepithelial fibrosis (p = 0.001) and hemorrhagic areas in the connective tissue (p = 0.002) was observed statistically significantly higher in the standard MMC group than in thermotherapy with normal saline group. There was almost a significant difference among standard MMC and normal saline group in terms of vascular congestion in the connective tissue (p = 0.08). Presence of epithelial vacuolar degeneration (p = 0.002), epithelial hyperplasia (p = 0.002), subepithelial fibrosis (p = 0.030), hemorrhagic areas (p = 0.011) and vascular congestion (p = 0.36) in the connective tissue was observed statistically significantly higher in the thermochemotherapy with MMC group than in standard intravesical MMC group. Polymorphonuclear cell infiltration was not considerable in any of the groups, and there was no significant difference between each groups (p = 0.140). Administration of intravesical MMC causes a toxic effect on the normal urothelium of the bladder rather than an inflammatory reaction. Heating MMC significantly increased this effect.

Bare sclera resection followed by mitomycin C and/or autograft limbus conjunctiva in the surgery for pterygium: a Meta-analysis.

To evaluate the recurrence and complications after bare sclera resection (BSR) combined with mitomycin C (MMC) treatment and/or autograft limbus conjunctiva (ALC) in the surgery for pterygium. Meta-analysis was used to evaluate the differences in patient outcomes between BSR of pterygium with or without MMC and/or ALC. All included studies were randomized trials of patients with pterygium who received BSR followed by MMC and/or ALC in the surgery. The recurrence of pterygium and other complications resulting from different treatments were extracted for analysis. Thirteen studies met the inclusion criteria. The recurrence of pterygium with intraoperative (IO) MMC was higher than that with ALC (OR=2.38, 95% confidence interval 1.45-3.91, I (2)=29%). Postoperative MMC resulted in an incidence of recurrence similar to that of ALC (OR=0.66, 95% confidence interval 0.30-1.42, I (2)=0%), and IO MMC treatment in combination with ALC produced similar patient outcomes to ALC alone (OR=0.41, 95% confidence interval 0.16-1.01, I (2)=16%). Other complications such as punctate epitheliopathy, scleral thinning and ischemia, irritation and persistent epithelium defect, were more common in patients in the MMC group as compared to those treated with ALC. The recurrence of pterygium with BSR followed by ALC is lower than that of BSR followed by MMC, and the incidence of other complications is lower. While ALC is a more effective strategy for treating pterygium, the quality of the ALC transplant should be considered when the patient has a history of glaucoma.

Celecoxib for the prevention of nonmuscle invasive bladder cancer: results from a matched control study.

New targets and approaches are under investigation for the treatment of nonmuscle invasive bladder cancer (NMIBC). Preclinical data suggest cyclooxygenase-2 (COX-2) as a promising target. Celecoxib, a COX-2 selective inhibitor, inhibits tumor development and enhances survival, both in vitro and in vivo models of bladder cancer. Therefore, we conducted a pilot study of celecoxib to prevent recurrence in patients with intermediate risk NMIBC. Treatment with celecoxib was administered orally for 12 months and compared with a contemporary series of patients treated with intravesical mitomycin C (MMC), given weekly for 4 weeks and then monthly for 11 months. Primary endpoints were time to first recurrence and adverse events. From 2003 through 2006, 58 patients were treated with celecoxib and compared with 66 patients receiving MMC. After a median follow up of 75 months, 49 patients were disease free, including 23 (34.85%) in the MMC group and 26 (44.8%) in the celecoxib group. Median disease-free interval was 67 months [95% confidence interval (CI) 35.8 to NA] versus 41 months (95% CI 27.1-67.1; log-rank p = 0.25) for patients treated with MMC and celecoxib, respectively. In the multivariate analysis, treatment was not found to be an independent predictor for recurrence [hazard ratio (HR) 0.76, 95% CI 0.47-1.22, p = 0.25). Overall, 45 AEs were recorded in 35/124 patients. There were no differences between the two groups. Our data support a clinical benefit of celecoxib and encourage future trials in which COX-2 inhibitors may be tested in selected patients with NMIBC.

Evaluation of antioxidant, enzyme inhibition, and cytotoxic activity of three anthraquinones (alizarin, purpurin, and quinizarin).

The aim of this work was to investigate the cytotoxic, antioxidative, and enzyme inhibition effects of alizarin, quinizarin, and purpurin, which are anthraquinones (AQ). Cytotoxic effects were evaluated with cell inhibition rate by 3-(4,5-dimethylthiazol- 2-yl)-2,5-diphenyltetrazolium bromide assay. Different chemical assays, including free radical scavenging activity (1,1-diphenyl-2-picrylhydrazyl and 2,2-azino-bis(3-ethylbenzothiazloine-6-sulfonic acid)), phosphomolybdenum and reducing power (ferric reducing antioxidant power and cupric ion reducing activity), were used to evaluate the antioxidant properties. Moreover, enzyme inhibitory activities were analyzed against acetylcholinesterase, butrylcholinesterase, tyrosinase, α-amylase, and α-glucosidase. These components have antioxidant and enzyme inhibition activity. Especially, purpurin showed the strongest antioxidant and good enzyme inhibitory effects. According to our cytotoxicity results, alizarin, purpurin, and quinizarin induced dose- and time-dependent cell proliferation. Furthermore, when we applied AQs with mitomycin C (MC) on L929 cell line, we demonstrated that cell proliferation in MC-AQ groups compared with MC group was increased. The most effective component was alizarin at 100 µM concentration. These AQs showed positive effects on L929 cell lines with high half-maximal inhibitory concentration values. Our results demonstrate that AQs may be used as antioxidative compounds in food and medicinal applications.

A comparison of amniotic membrane and Mitomycin C applied in glaucoma trabeculectomy

Objective To compare the anti-scarring effects of amniotic membrane and mitomycin C in glaucoma trabeculectomy. Methods Sixty-eight eyes of 38 cases of angle closure glaucoma were divided into mitomycin C (MMC) group and amniotic membrane group with 34 eyes in each group.In MMC group, the MMC with concentration of 0.3mg/ml was applied only once for 3 min. Patients in amniotic membrane group underwent trabeculectomy combined with amniotic membrane implantation under scleral flap. Patients were followed up for 10 months. Results The total success rate, including conditional success rate and cumulative complete success rate was 81.05% and the complete success rate was 62.03% in MMC group, and they were 94.02% and 82.09% in amniotic membrane group. The differences were statistically significant between two groups (χ2=2.403, P=0.238; χ2=2.101, P=0.210). Postoperative complications in amniotic membrane group included postoperative shallow anterior chamber in 6 eyes, cataract in 2 eyes, hyphema in 2 eyes and thin bleb in 2 eyes. Postoperative complications in MMC group were mainly shallow anterior chamber in 8 eyes, cataract in 7 eyes, hyphema in 9 eyes, thin-wall bleb in 9 eyes, leaking filtering blebs in 6 eyes, persistent hypotony in 9 eyes, and macular disease caused by low intraocular pressure in 6 eyes. Conclusion Amniotic membrane used in trabeculectomy can effectively prevent the scar formation of blebs in operation, and can effectively preserve the functional follicles for a long time with less complication than MMC. Key words: Glaucoma; Trabeculectomy; Mitomycin C; Amnion

Effects of Gelatin Hydrogel Loading Mitomycin C on Conjunctival Scarring in a Canine Filtration Surgery Model.

To investigate the effects and toxicities of gelatin hydrogel (GH) loading mitomycin C (MMC) on IOP and conjunctival scarring in a canine model of glaucoma surgery in comparison with conventional MMC application. Glaucoma surgery models were made in six beagles. An MMC-loaded GH was implanted under the conjunctiva of one eye (GH-MMC group) and 0.04% MMC-soaked sponges were placed under the conjunctiva of the other eye (MMC group) for 5 minutes. Intraocular pressures and bleb features were then assessed for 4 weeks postoperative, followed by histological evaluation. The ratio of conjunctival area to scleral area, the densities of collagen and the numbers of fibroblasts, vessels, and proliferative cell nuclear antigen (PCNA)-positive cells were then quantified. In both groups, IOP reduction and bleb formation were maintained in a similar manner for 4 weeks postoperative. No significant difference in the ratio of conjunctival area to scleral area was found between the two groups. Collagen density and the numbers of fibroblasts and vessels were significantly lower in the MMC-treated group than in the GH-MMC-treated group. No significant difference in PCNA-positive cells was found between the two groups. Implantation of MMC-loaded GH ameliorated toxicity to conjunctiva compared with the 5-minute placement of MMC, whereas its effect on IOP reduction and bleb formation was similar. These results suggest that using GH for the application of MMC is a safer method than the conventional application of MMC in glaucoma filtration surgery.

The Suppression of Wound Healing Response with Sirolimus and Sunitinib Following Experimental Trabeculectomy in a Rabbit Model

Purpose: To investigate the effects of sirolimus and sunitinib on wound healing in experimental glaucoma filtering surgery (GFS).Material and Methods: Thirty-five male New Zealand pigmented rabbits were randomly assigned to five groups, each including seven rabbits: The rabbits in the control group were not operated on and did not receive any treatment. The rabbits in the sham group underwent trabeculectomy and had one drop of saline instilled four times a day for 14 days. The rabbits in the mitomycin-C (MMC) group underwent trabeculectomy, and a sponge soaked in 0.4 mg/mL MMC was applied intraoperatively to the scleral surgical site for three minutes. The rabbits in the sirolimus group underwent trabeculectomy and 30 ng/mL sirolimus-soaked sponge was applied intraoperatively to the scleral surgical site for three minutes. Sunitinib 0.5 mg/mL four drops in a day were applied in the sunitinib group for 14 days after surgery. On day 14 of the experiment, eyes were enucleated and histologically and immunohistochemically analyzed. Statistical analyses of the study were performed with Kruskal–Wallis variance analysis and Mann–Whitney U test.Results: The mean fibroblast and MNC numbers and the mean immunostaining intensities of transforming growth factor-β (TGF-β), fibroblast growth factor-β (FGF-β) and platelet derived growth factor (PDGF) in the MMC, sirolimus and sunitinib groups were statistically significantly lower than those of the sham group (p < 0.01). The mean fibroblast and MNC numbers and the mean immunostaining intensities of TGF-β, FGF-β and PDGF in the MMC, sirolimus and sunitinib groups were similar (p > 0.05).Conclusions: Our study suggests that the applications of sirolimus and sunitinib effectively suppress the subconjunctival scarring after experimental GFS.

Comparison study on the efficacy and safety of bevacizumab versus mitomycin C as adjuvants in trabeculectomy

ObjectiveThe objective of this study is to compare the efficacy and safety of bevacizumab versus mitomycin C as an adjuvant anti-scarring agent in trabeculectomy. MethodsA prospective, comparative, non-randomized, interventional study was conducted on a case series. A total of 49 eyes of 45 patients with uncontrolled glaucoma were recruited: 22 eyes in the bevacizumab (BVZ) group, and 27 eyes in the mitomycin C (MMC) group. Complete success was defined as intraocular pressure (IOP) less than 18mmHg without any antiglaucoma medications. Follow-up visits were made on 1, 7, 30, 90 and 180 days after the surgery. Visual acuity, mean IOP, number of antiglaucoma medications and additional procedures to control IOP were recorded at each follow up visit. Local and systemic complications were also noted. ResultsAt the end of the follow-up there were no significant differences in mean IOP between groups: mean IOP was 13.4±3.5mmHg (range 8–20) in the BVZ group and 11.6±2.6mmHg (range 7–17) in the MMC group (p=.08). Complete success was achieved in 77.2% (17 out of 22) in the BVZ group and 96.2% (26 out of 27) in the MMC group, which was a statistically significant difference (p=.024). More patients required antiglaucoma medications to control IOP in the BVZ group at the end of the study: 0.36±0.72 medications versus 0.03±0.19 medications in the MMC group (p=.018). Three patients developed avascular cystic blebs in the BVZ group. None of the patients suffered any ocular or systemic complications related to the use of these agents. ConclusionBevacizumab could be a safe and effective anti-scarring agent; however IOP reduction appears to be greater with MMC, and also less antiglaucoma medications are needed with this anti-scarring agent. Bevacizumab could favor the formation of avascular cystic blebs.

Efficacy of Adjunctive Subconjunctival Bevacizumab on the Outcomes of Primary Trabeculectomy With Mitomycin C: A Prospective Randomized Placebo-controlled Trial.

Purpose:To evaluate the efficacy of subconjunctival bevacizumab (ScB) as adjuvant therapy to primary trabeculectomy with mitomycin C (MMC) in primary open-angle glaucoma.Materials and Methods:Forty-six eyes of primary open-angle glaucoma patients were randomized to receive ScB (1.25 mg/0.05 mL) injections (the MMC+ScB group) at the end of the operations, or sham-treated controls (the MMC group). Intraocular pressure (IOP) was the primary outcome and secondary outcomes included bleb appearance, visual acuity, number of medications, complications, and proportion of eyes achieving successful outcomes at the 12-month follow-up.Results:Of 39 eyes, 20 eyes from the MMC+ScB group, and 19 eyes from the MMC group completed the follow-up. The mean postoperative IOP was 15.5±4.1 mm Hg in the MMC+ScB group (P<0.01; 40% reduction), and 14.7±4.3 mm Hg in the MMC group (P<0.01; 44% reduction). The differences in IOPs, at all follow-up visits, were not significant (P>0.05). The mean bleb vascularity score, at 1 month, in the MMC+ScB group was lower than the MMC group (1.55±0.51 vs. 2.26±0.6, respectively, P=0.01), but was not retained at follow-ups. The success rates at 12 months after surgery were 85% in the MMC+ScB group and 89.5% in the MMC group (P=0.53). The cumulative probabilities of surgical success were 80% and 73.7% in the MMC+ScB and in the MMC group, respectively (P=0.52).Conclusion:Single adjunctive ScB injection did not appear to have an additive benefit on outcomes of MMC trabeculectomy, in terms of IOPs and success rates.

Trabeculectomy with collagen matrix implantation versus trabeculectomy with mitomycin C application for the treatment of primary congenital glaucoma

Purpose To compare the results in terms of the efficacy and safety of collagen matrix implant [Ologen (OLO) implant] versus mitomycin C (MMC) in trabeculectomy for the surgical treatment of primary congenital glaucoma. Materials and methods Twenty eyes of 15 patients with primary congenital glaucoma were divided into two groups. The first group (MMC group) included 10 eyes that were subjected to trabeculectomy with MMC. The second group (OLO group) included 10 eyes that were subjected to trabeculectomy with a collagen matrix implant (OLO implant). All procedures were performed in Sohag University Hospital. Postoperative evaluation included intraocular pressure (IOP) level, bleb evaluation, complications, and the need for further medication or surgical intervention. The postoperative IOP level was classified into four groups (>21, >17-21, 15-17, and Results At the end of the sixth postoperative follow-up month, in the MMC group, only 10% of eyes achieved the target IOP, 10% of eyes had failed surgery, and 80% of eyes had IOP ranging from 15 to 21 mmHg. However, in the OLO group, 40% of eyes achieved the target IOP, 60% of eyes had IOP ranging from 15 to 21 mmHg, and there were no failed surgeries. In terms of complications, the MMC group had a higher rate of complications than the OLO group in the form of early hyphema, bleb leakage, hypotony, and choroidal detachment. Conclusion This study proved that the use of a collagen matrix implant yields more effective results than MMC when combined with trabeculectomy for the treatment of primary congenital glaucoma. Furthermore, OLO implantation is safe and has low incidences of complications. Because of the small sample size in this study, which limits the statistical comparison between the groups, further larger studies are required to investigate the long-term efficacy and safety of this new device.

Deep Sclerectomy With Bevacizumab and Mitomycin C

To assess the comparative efficacy and safety of primary deep sclerectomy (DS) augmented with subconjunctival Bevacizumab and intraoperative Mitomycin C (MMC). Retrospective, comparative case-control series of consecutive primary DS between January 2008 and December 2010. Seventy-five eyes of 73 patients were included, with 32 eyes in the MMC and 43 in the Bevacizumab group. MMC (0.2 mg/mL for 2 min) was applied subconjunctivally before scleral flap dissection. Bevacizumab (2.5 mg in 0.1 mL) was injected subconjunctivally at the end of surgery. Complete success was intraocular pressure (IOP) <19 mm Hg and a 20% decrease from baseline with no postoperative medications. There were no significant baseline differences between the groups. Follow-up after DS was 33.3 ± 6.1 months for the Bevacizumab and 35.0 ± 10.2 months for the MMC group (P=0.34). Complete success rates were 90.7% [95% confidence interval (CI), 82.4%-99.8%] and 87.5% (95% CI, 76.8%-99.7%) at 1 year and 76.5% (95% CI, 64.8%-90.4%) and 74.4% (95% CI, 60.5%-91.4%) at 2 years after DS in the Bevacizumab and MMC groups, respectively (P=0.52). There was no statistical difference in mean IOPs between the groups at all specified time intervals up to 2 years (P=0.28). At last follow-up 2 (6.2%) of the MMC and 2 (4.7%) eyes of Bevacizumab group were on medications to control IOP. Eighteen eyes had complications, 9 (20.9%) in Bevacizumab and 9 (28.1%) in the MMC group (P=0.8). Subconjunctival Bevacizumab with primary DS appears to be as efficacious as MMC augmentation with no additional side effects.

Role of Subconjunctival Bevacizumab as an Adjuvant to Primary Trabeculectomy

To compare the safety and efficacy of primary trabeculectomy with adjunctive subconjunctival bevacizumab with that of primary trabeculectomy with mitomycin C (MMC). Forty-two patients with primary open-angle glaucoma were studied. Randomly, subject's eyes underwent primary trabeculectomy with either subconjunctival bevacizumab (2.5 mg/0.1 mL) or topical MMC (0.2 mg/mL for 3 min). The intraocular pressure (IOP) was the primary outcome measure. Secondary outcome measures included the corrected distance visual acuity, number of antiglaucoma medications, postoperative interventions and complications, bleb evaluation (on the basis of Moorfields Bleb Grading System), and the percentage of eyes achieving target pressure of 21, 18, 15, and 12 mm Hg at 6 and 12 months postoperatively. Of the 42 eyes, 21 treated with subconjunctival bevacizumab while 21 were treated with MMC. The mean preoperative IOP in the bevacizumab group improved from 23.9 ± 2.7 mm Hg with 2.6 ± 0.7 antiglaucoma medications to 13.9 ± 2.8 mm Hg with 0.6 ± 0.9 antiglaucoma medications at 12 months (P<0.001 and P<0.001, respectively). The mean preoperative IOP in MMC group improved from 22.9 ± 2.6 mm Hg with 2.7 ± 0.8 antiglaucoma medications to 12.2 ± 3.2 mm Hg with 0.1 ± 0.5 antiglaucoma medications at 12 months (P<0.001 and P<0.001, respectively). At 12 months, 15 of 21 (71%) eyes in the MMC group met a target IOP of 12 mm Hg without antiglaucoma medication while 7 of 21 (33%) eyes in the bevacizumab group did (P=0.02). Encapsulated bleb was seen in 2 (10%) patients in MMC group and in 6 (29%) patients in bevacizumab group (P=0.23). Although subconjunctival bevacizumab is effective and safe in primary trabeculectomy, IOP control appears to be superior with MMC, in terms of complete success with a target IOP<12 mm Hg and number of antiglaucoma medications required postoperatively.

Twelve-Year Outcomes of Pterygium Excision with Conjunctival Autograft versus Intraoperative Mitomycin C in Double-Head Pterygium Surgery.

Purpose. The study aims to compare the long-term outcome of conjunctival autograft (CAU) and mitomycin C (MMC) in double-head pterygium surgery. Methods. This is a follow-up study of a comparative interventional trial. Thirty-nine eyes of the 36 patients with double-head pterygium excision in the original study 12 years ago were recruited for clinical assessment. Seven out of the 36 patients were lost. In the original study, each eye with double-head pterygium was randomized to have pterygium excision with CAU on one “head” (temporal or nasal) and MMC on the other “head.” All patients were invited for clinical assessment for conjunctival bed status and the presence of pterygium recurrence in the current study. Results. There was no significant difference between the size, morphology, and type of pterygium among the two treatment groups. The recurrence rate of CAU group and MMC group 12 years after excision was 6.3% and 28.1%, respectively (P = 0.020). Among eyes without recurrence, the conjunctival bed was graded higher in the MMC group than the CAU group (P = 0.024). Conclusion. The use of conjunctival autograft has a significantly lower long-term recurrence rate than mitomycin C in double-head pterygium surgery.

Estudio comparativo sobre eficacia y seguridad de bevacizumab frente a mitomicina C como adyuvantes a trabeculectomía

ObjectiveThe objective of this study is to compare the efficacy and safety of bevacizumab versus mitomycin C as an adjuvant anti-scarring agent in Trabeculectomy. MethodsA prospective, comparative, non-randomized, interventional study was conducted on a case series. A total of 49 eyes of 45 patients with uncontrolled glaucoma were recruited: 22 eyes in the bevacizumab (BVZ) group, and 27 eyes in the mitomycin C (MMC) group. Complete success was defined as intraocular pressure (IOP) less than 18mmHg without any antiglaucoma medications. Follow-up visits were made on 1, 7, 30, 90 and 180 days after the surgery. Visual acuity, mean IOP, number of antiglaucoma medications and additional procedures to control IOP were recorded at each follow up visit. Local and systemic complications were also noted. ResultsAt the end of the follow-up there were no significant differences in mean IOP between groups: mean IOP was 13.4 ± 3.5mmHg (range 8-20) in the BVZ group and 11.6 ± 2.6mmHg (range 7-17) in the MMC group (P=.08). Complete success was achieved in 77.2% (17 out of 22) in the BVZ group and 96.2% (26 out of 27) in the MMC group, which was a statistically significant difference (P=.024). More patients required antiglaucoma medications to control IOP in the BVZ group at the end of the study: 0.36 ± 0.72 medications versus 0.03 ± 0.19 medications in the MMC group (P=.018). Three patients developed avascular cystic blebs in the BVZ group. None of the patients suffered any ocular or systemic complications related to the use of these agents. ConclusionBevacizumab could be a safe and effective anti-scarring agent; however IOP reduction appears to be greater with MMC, and also less antiglaucoma medications are needed with this anti-scarring agent. Bevacizumab could favor the formation of avascular cystic blebs.

Role of recombinant human erythropoietin against mitomycin C-induced cardiac, hepatic and renal dysfunction in Wistar rats.

Mitomycin C (MMC) is one of the most effective chemotherapeutic drugs. However, the dose of MMC is greatly limited by its toxicity in normal tissues. Recombinant human erythropoietin (rhEPO), an erythropoietic hormone, has also been shown to exert tissue protective effects. The purpose of this study was to explore the protective effect of rhEPO against MMC-induced heart, liver, and renal dysfunction. Adult male Wistar rats were divided into six groups (with six animals each), namely control, rhEPO alone group, MMC alone group, and rhEPO + MMC group (pre-, co-, and posttreatment conditions). The results showed that MMC induced a marked cardiac, renal, and liver failure characterized by a significant decrease in body weight, organs weight, and organs ratio and a significant increase in creatinine, blood urea nitrogen, alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transferase, and conjugated and total bilirubin levels in serum. Histological examination showed that MMC caused liver alterations. rhEPO treatment restored body weight, organs weight, and organs ratio as well as serum biochemical parameters and histological damage caused by MMC exposure.

Effect of mitomycin, bevacizumab, and 5-Fluorouracil to inhibit urethral fibrosis in a rabbit model.

Mitomycin C (MMC), bevacizumab, and 5-fluorouracil (5-FU) are frequently used in cancer treatment. Each of these agents also exhibits antiproliferative properties in different tissues. We compared the efficacy of MMC, bevacizumab, and 5-FU may inhibit urethral fibrosis (UF) without statistically significant differences among them. Forty male rabbits with traumatized urethras were divided into four groups: Group 1 (control), no medical treatment; group 2, MMC applied to the traumatized area; group 3, bevacizumab applied to the traumatized area; and group 4, 5-FU applied to the traumatized area. All animals were euthanized after 28 days to evaluate the presence of chronic inflammation and fibrosis. Tissue samples were subjected to hematoxylin and eosin and Masson trichrome staining to assess the presence of fibrosis, the state of the epithelium, and collagen density. The MMC and control groups showed the most significant difference in outcomes (P<0.001), followed by the bevacizumab (P=0.002) and 5-FU groups (P=0.005). No statistically significant difference was noted when all three treatment groups were compared with one another. Histopathologic examination revealed inflammatory cell infiltration in the connective tissue, irregular collagen bundles, increased fibroblasts, and a moderate degree of fibrosis in the control group. Compared with controls, all treatment groups exhibited mild fibrosis, less collagen bundle irregularity, and lower numbers of fibroblasts. MMC, bevacizumab, and 5-FU may inhibit UF. There were no statistically significant differences in the effectiveness among the three agents.

Ranibizumab Versus Mitomycin C in Primary Trabeculectomy – A Pilot Study

ABSTRACTPurpose: The current standard adjunctive agent used in primary trabeculectomy is mitomycin C (MMC), but it is associated with well known complications. The objective of this study is to test the feasibility of the anti-vascular endothelial growth factor (anti-VEGF) agent ranibizumab for adjunctive use instead of MMC (0.4 mg/ml).Materials and methods: A prospective, randomized open label study of 24 consecutive patients undergoing primary trabeculectomy at the Wills Eye Institute Glaucoma Service from March 2008 through February 2010 was conducted. Twenty-four eyes were included in the study and clinical outcomes were examined.Results: There were no significant differences in baseline demographic or clinical characteristics between the ranibizumab and MMC groups. Nine of the 12 ranibizumab patients completed the 1 year study. Three subjects required tube shunt surgery and were removed from the study. Eleven of 12 MMC patients completed the study (one underwent hip surgery and was lost to follow-up). Mean intra-ocular pressure (IOP) was significantly higher in the ranibizumab arm at 1 month (p = 0.002). Bleb extent was significantly less in the ranibizumab arm at 6 months (p = 0.006). Patients in the ranibizumab arm required more hypotensive medication at month 3 (p = 0.011).Conclusions: Although there was no IOP difference or difference in medication use between the two treatment groups at one year, more patients in the ranibizumab group required additional glaucoma surgery during the study period.

Ologen Implant versus Mitomycin C for Trabeculectomy: A Systematic Review and Meta-Analysis

ObjectiveTo evaluate the application of the Ologen implant compared to mitomycin C (MMC) on the outcome of trabeculectomy and to examine the balance of risks and benefits.MethodsA systematic literature search (Pubmed, Embase, the Cochrane Library, and the Chinese Biomedicine Database) was performed. Randomized controlled trials comparing the Ologen implant with MMC in trabeculectomy were selected. The efficacy measures were the weighted mean differences (WMDs) for the intraocular pressure reduction (IOPR), the reduction in glaucoma medications, and the relative risks (RRs) for success rates. The tolerability measures were RRs for adverse events. The pooled effects were calculated using the random-effects model.ResultsSeven randomized controlled trials including 227 eyes were included in this meta-analysis. The WMDs of the IOPR comparing the Ologen group with the MMC group were −2.98 (95% Cl: −5.07 to −0.89) at one month, −1.41 (−3.72 to 0.91) at three months, −1.69 (−3.68 to 0.30) at six months, −1.94 (−3.88 to 0.01) at 12 months, and 0.65 (−2.17 to 0.47) at 24 months. There was no statistically significance except at one and 12 months after surgery. No significant difference in the reduction in glaucoma medications or complete and qualified success rates were found. The rates of adverse events also did not differ significantly between Ologen and MMC.ConclusionsThe Ologen implant is comparable with MMC for trabeculectomy in IOP-lowering efficacy, reduction in the number of glaucoma medications, success rates, and tolerability. However, the results should be interpreted cautiously since relevant evidence is still limited, although it is accumulating. Further large-scale, well-designed randomized controlled trials are urgently needed.

Trabeculectomy Using Mitomycin C versus an Atelocollagen Implant: Clinical Results of a Randomized Trial and Histopathologic Findings

Purpose: To assess the efficacy of trabeculectomy with a biodegradable Ologen™ implant (OLO) versus mitomycin C (MMC) in patients in a prospective randomized clinical trial. Methods: In the MMC group (15 patients), trabeculectomy was performed according to standard protocols. In the OLO group (15 patients) after standard trabeculectomy, the implant was positioned on top of the scleral flap, and no MMC was applied. Results: Mean preoperative intraocular pressure (IOP) levels (OLO: 28.0 ± 9.4; MMC: 23.9 ± 5.0 mm Hg; p = 0.21) and medication score (OLO: 3.4 ± 1.6; MMC: 3.6 ± 1.5; p = 0.56) were comparable in both groups. One year after surgery, the mean IOP was 15.9 ± 4.5 mm Hg in the OLO group (p < 0.01, 43% reduction) and 11.0 ± 2.6 mm Hg in the MMC group (p < 0.01, 54% reduction). The surgical success rate 12 months after surgery was 93.3% in the MMC group and 40% in the OLO group (p = 0.01). Conclusions: With the atelocollagen-glycosaminoglycan matrix OLO it was not possible to reach the surgical success rate and pressure reduction achieved in the MMC group.

English

AIM: To compare surgical techniques for pterygium using mitomycin-C/5-fluorouracil as adjunct to surgery. SETTINGS AND DESIGN: A randomized, interventional, prospective, comparative study was conducted in Department of Ophthalmology, S.N Medical College, Agra for 2 years. MATERIALS AND METHODS: Patients underwent complete preoperative evaluation (complete history and ophthalmological examination). Ninety-eight eyes of 98 selected cases were divided into eight groups depending upon treatment protocol: I-Mitomycin-C (0.02%) with bare sclera II- Mitomycin-C (0.04%) with bare sclera III- Mitomycin-C (0.02%) with conjunctival autograft IV- Mitomycin-C (0.04%) with conjunctival autograft V-5-fluorouracil (10mg/ml) with bare sclera VI-5-fluorouracil (20mg/ml) with bare sclera VII-5-fluorouracil (10mg/ml) with conjunctival autograft VIII-5-fluorouracil (20mg/ml) with conjunctival autograft STATISTICAL ANALYSIS: Chi-square test was used to compare the outcome. RESULTS: Of 98 cases, 61 (62.24%) were male, 37 (37.75%) were female. The age ranged 18-66 years, with mean age of 44.6 years. Maximum cases were in age group 41-50 (48.98%). Seventy-nine (80.61%) had primary pterygium while 19 (19.39%) cases had recurrence. 74.49% were from rural area and 25.51% from urban background. 75.51% were outdoor workers while 24.49% were indoor workers. Involvement was bilateral in 71 (72.45%) cases. Ninety-five (96.94%) cases had nasal pterygium and 3 (3.06%) had both nasal and temporal. Most patients (73.47%) presented with complaint of ʿ growth in eyeʿ , followed by redness/congestion (16.33%). At reporting, corneal involvement in majority (64.28%) was 1-3 mm, and most patients (53.06%) consulted between 6-12 months of onset. The success rates, recurrence rates and ocular complications varied in various groups. The success rate was maximum (100%) in group-IV and minimum (72.73%) in group-V. Within mitomycin-C groups, conjunctival autograft revealed better results against bare sclera technique. No significant difference existed between low and high concentration groups with mitomycin-C or 5-fluorouracil, and even the mitomycin-C versus 5-fluorouracil groups. Groups IV and VIII revealed higher rate of complications including graft-injection and retraction (46.15% and 23.07% in Group-IV, and 61.54% and 23.07% in group-VIII), hematoma (23.07% and 30.77% in group-IV and VIII respectively), dry- eye (15.38% and 7.69% in group-IV and VIII ), granulation-tissue formation (7.69% in both), and scleral-thinning (7.69% in group-IV).