Subconjunctival Injection Of mitomycin-C Research Articles

Two routes of administration of mitomycin C in a trabeculectomy.

The introduction of mitomycin C (MMC) as an adjunct to trabeculectomy was a major advance in the ability to improve the Intra ocular pressure lowering efficiency of the procedure. The time tested traditional way of administration of MMC is via a sponges soaked in it, duration and concentration varies depending on risk of failure. A subconjunctival injection of MMC instead of these sponges is recently being used as a promising alternative. Here is the video demonstrating the 2 possible ways to prepare and apply MMC during a trabeculectomy surgery. Intraoperative injection of MMC in trabeculectomy has several advantages over conventional method ofsponge application. A large MMC treatment area produces more diffuse and elevated blebs. Large-area MMC application also seems to increase long-term success without increasing the complication rates in trabeculectomies. Direct and diffuse application of MMC by injection may promote less scarring and vascularization of the bleb. To achieve the same surface area of exposure with sponges, i.e.achieved with injection, the surgeon must use multiple sponges, all of which must be carefully collected thereafter. The injection method,therefore,eliminates the risk of retained sponges. injection of MMC may be as safe and as effective as conventional sponge application of MMC with comparable estimated complete treatment success with relatively lower complication rates. https://youtu.be/RLEbK4IeRtU.

A novel approach of subconjunctival Mitomycin C injection at the end of trabeculectomy for secondary glaucoma: A pilot study

Purpose: To describe for the first time, a new approach of subconjunctival Mitomycin-C (MMC) injection at the end trabeculectomy for secondary glaucoma. Materials and Methods: This pilot study consisted of 4 eyes of 4 patients of uncontrolled secondary glaucoma. After preoperative glaucoma workup, all patients underwent standard trabeculectomy with subconjunctival MMC injection, 0.1ml (0.02mg) in superonasal quadrant at the end of surgery. Postoperative follow-up included assessment of visual acuity, intraocular pressure (IOP), bleb, anterior chamber depth and for any complications. The success criterion was IOP of ?21 mmHg. Results: The mean pre and postoperative IOP were 43 mmHg± 16.2 and 12.00mmHg ± 1.6 respectively with a success rate of 100% during a mean follow up of 15.5 months. Blebs were mildly elevated, diffuse and less avascular. No intraoperative complications were seen. Postoperative wound leak, flat anterior chamber, hypotony, choroidal detachment or endophthalmitis were not encountered. Conclusion: This novel approach of subconjunctival MMC injection at the end of trabeculectomy was found to be safe and highly effective in secondary glaucoma without any MMC related complications. Keywords: Mitomycin C, Subconjunctival injection, Secondary glaucoma, Trabeculectomy.

Comparison of Subconjunctival Mitomycin C and 5-Fluorouracil Injection for Needle Revision of Early Failed Trabeculectomy Blebs

Background. To compare the efficacy of needle revision with 5-fluorouracil (5-FU) and mitomycin C (MMC) on dysfunctional filtration blebs shortly after trabeculectomy. Methods. It is a prospective randomized study comparing needle revision augmented with MMC or 5-FU for failed trabeculectomy blebs. Results. To date 71 patients (75 eyes) have been enrolled, 40 eyes in the MMC group and 35 in the 5-FU group. 68 patients (72 eyes) have completed 12-month follow-up, 38 eyes in the MMC group and 34 in the 5-FU group. The mean IOP before and that after needle revision in the MMC group were 26.5 ± 4.3 mmHg and 11.3 ± 3.4 mmHg, respectively (P < 0.05), and in the 5-FU group were 27.1 ± 3.8 mmHg and 10.9 ± 3.4 mmHg, respectively (P < 0.05). At 12-month follow-up, complete success rates were 57.5% for MMC group and 34.3% for 5-FU group (P = 0.042; log-rank test) and 75% and 60% (P = 0.145; log-rank test), respectively, for the qualified success. Complication rates between the two groups were not statistically different (P > 0.05). Conclusions. Needle revision and subconjunctival MMC injection were more effective than needling and subconjunctival 5-FU injection for early dysfunctional filtration blebs after trabeculectomies.

Pre- and intraoperative mitomycin C for recurrent pterygium associated with symblepharon

BackgroundTreatment of recurrent pterygium associated with symblepharon usually involves the use of tissue grafting and/or the intraoperative application of mitomycin C (MMC). For the graft, a conjunctival/limbal autograft and/or amniotic membrane may be used. This generally requires extra technical skills and assistance, an increase in the cost and duration of surgery, and a more extensive anesthesia (a complete eye block or general anesthesia). Although widely used, safety concerns have been raised over MMC in the treatment of pterygia.ObjectiveThe objective of this case report is to report the successful use of preoperative subconjunctival injection of low-dose (0.02%) MMC one month before bare sclera excision of a multirecurrent pterygium, as well as the concomitant intraoperative application of MMC to the conjunctival fornix of the same eye after the excision of an associated symblepharon.Case reportA 31-year-old man from Kano, Northern Nigeria, presented to the eye clinic with a recurrent pterygium associated with an upper lid symblepharon in his right eye. He has had five previous pterygium excisions, with the last surgery involving conjunctival autografting and subconjunctival steroid injection. He was subsequently given 0.1 mL of 0.02% MMC as a subpterygial injection; one month later he had an alcohol-assisted bare sclera pterygium excision and a symblepharolysis with the intraoperative application of 0.02% MMC for 1 minute to the upper conjunctival fornix. Except for a Tenon granuloma that was simply excised, there has been no recurrence or other complications up to a year after surgery.ConclusionAs a cheaper and technically easier treatment option, a preoperative subconjunctival MMC injection followed by bare sclera pterygium excision was found to be effective in this patient with a recurrent pterygium. As at one-year follow-up, low-dose preoperative MMC a month prior to surgery also appeared safe and effective when combined with its intraoperative application to the conjunctival fornix for the treatment of associated symblepharon.

Subconjunctival Mitomycin C Before Pterygium Excision

Subconjunctival injection of mitomycin C (MMC) before pterygium excision is a new adjunctive therapy to decrease pterygium recurrence. This study aimed to investigate the ultrastructural changes in pterygium after subconjunctival injection of MMC. Four patients underwent subconjunctival injection of 0.1 mL of 0.15 mg/mL MMC 1 month before pterygium excision, and 2 patients served as controls without preoperative MMC injection. The excised specimens of pterygium were examined under transmission electron microscopy. Epithelial cells of the treated pterygium remained unchanged. However, stromal fibroblasts were decreased in number, were oval rather than spindle-shaped, and had shrunken cytoplasmic processes; some were degenerating or apoptotic. Collagen and elastic fibers were decreased in density, disorganized, and degenerated. Capillary endothelial cells were thickened and swollen, with narrow or obliterated lumens. Axonal swelling and demyelination were observed. Subconjunctival injection of MMC inhibits fibrovascular activity in the pterygial stroma, leading to degeneration of the extracellular matrix and nerve axons. These ultrastructural changes are consistent with the clinical observation of reduced vascularity in the pterygium after MMC injection and verify the effectiveness of subconjunctival MMC injection 1 month before pterygium excision in decreasing the risk of pterygium recurrence.

Intraocular pressure reduction after subconjunctival mitomycin-C in absolute glaucomatous eyes

This study investigated the intraocular pressure (IOP) lowering effect of subconjunctival injection of mitomycin-C in human eyes blinded by glaucoma. Twenty eyes received injection of 1 mg of mitomycin-C and were followed up for 2 months. A statistically significant decline in IOP was observed until day 30 in all patients. The IOP-lowering effect of 1 mg of subconjunctivally injected mitomycin in patients with intractable glaucoma appears to be temporary.

Effects of subconjunctival injection of mitomycin-C on iridial circulation in rabbits

PURPOSE. To determine the effects of a subconjunctival injection of mitomycin-C (MMC) on iridial circulation in rabbits. METHODS. Dutch rabbits anesthetized with pentobarbital received a 0.2-ml subconjunctival injection of 0.4 mg/ml or 0.1 mg/ml MMC; the contralateral eye received 0.2 ml physiological saline. Intraocular pressure (IOP) and NB iris, a quantitative index of iridial tissue blood velocity, were measured up to 24 hours after treatment. RESULTS. At a dosage of 0.4 mg/ml MMC, NB iris obtained from the iridial area adjacent to the injection site decreased significantly by 13.6% and 18.6% at 1 and 2 hours (P = 0.03, 0.01, respectively) after treatment; NB iris obtained on the contralateral side of the injection showed no significant change. In eyes treated with 0.1 mg/ml MMC, NB iris did not change significantly. The mean IOP was significantly lower by 3.1, 3.0, and 1.8 mm Hg at 6, 12, and 24 hours after the 0.4 mg/ml injection of MMC compared with the fellow eyes (P = 0.03, 0.01, and 0.03, respectively), the IOP decreased by 1.7 mm Hg at 4 hours in the eyes treated with 0.1 mg/ml MMC (P = 0.04). CONCLUSIONS. Subconjunctival injections of 0.2 ml of 0.4 mg/ ml MMC caused not only a significant decrease of IOP but also a transient but significant effect on iridial circulation.

Antimetabolite Use in Revising Failing Filtering Blebs

This article evaluates the efficacy of a subconjunctival injection of mitomycin-C (MMC) followed by needling of the scar tissue to restore bleb function. By means of preoperative ultrasonic biomicroscopy, all the eyes in this study were categorized into one of three groups: Group I (bleb present), Group II (minimal bleb), and Group HI (no bleb present). This classification was carried out to try to control for differences in bleb appearance that may correlate with bleb function. The eyes in Group I (bleb present) had a statistically significant decrease in their intraocular pressure (IOP) from the initial IOP (Po) that Groups II (minimal bleb) and III (no bleb) eyes did not show. The final lOPs (Pf) for all three groups were statistically similar, suggesting that MMC bleb needling is more effective in lowering IOP when there still is a bleb present. If this is true, early intervention in the form of MMC bleb needling affords the surgeon the best opportunity to successfully restore the function of the failing bleb.

Indications for and Complications of Mitomycin-C in Pterygium Surgery

The purposes of this study are to examine the complications and results of a novel approach to the use of mitomycin-C in pterygium surgery; to identify the lowest effective dosage required to prevent recurrence; and to select those high-risk pterygia that could benefit from mitomycin-C use. One hundred thirty-five eyes of 128 patients considered at high risk for recurrence of pterygium were treated with a single, intraoperative, subconjunctival injection of mitomycin-C at the site of excision. Three different dosages-0.2, 0.1, and 0.05 ml-at a strength of 0.5 mg/ml were used. The eyes were observed for 10 months to 3 years. There were only two recurrences (1.5%); both occurred in eyes that had undergone previous pterygium surgery. One recurrence happened with the 0.2-ml dosage, and the other with the 0.1-ml dosage. These recurrences occurred in association with early wound dehiscence, which essentially became a bare sclera susceptible to pterygium regrowth. Complications included temporary and prolonged discomfort, tearing, hyperemia, subconjunctival hemorrhage, wound dehiscence, and pigment accumulation. No vision-threatening side effects were noted. The persistence and intensity of discomfort noted at the higher dosage has prompted these authors to suggest that only high-risk pterygia should receive mitomycin-C. Conjunctival flaps should always be used to cover the sclera up to the limbus and to localize the mitomycin-C to prevent its migration. A single dose of not more than 0.05 ml at a strength of 0.5 mg/ml subconjunctivally gives the same results as multiple drops, but with far less morbidity.

THC

Subconjunctival fibrosis is one of the major causes of most bleb failures. To inhibit the wound-healing process and to achieve a better intraocular pressure (IOP) lowering effect as well as bleb formation, we performed a sclerostomy using a THC:YAG laser (thulium, holmium, and chromium-doped yttrium-aluminum-garnet crystal) and a subconjunctival injection of mitomy-cin-C given 24 h or 5 days before a filtering operation or soon after the filtering process in rabbits. A 1-mm conjunctiva wound was made 12 mm away from the sclerostomy site to allow for entry of an optic probe for delivering energy. Forty-eight rabbits were divided into four groups. Group I received a subconjunctival injection of 0.2 ml of 0.2 mg/ml of mitomycin-C 24 h before the operation. The same dosage of mitomycin-C was given to Group II 5 days before the operation and to Group III immediately following the operation. Group IV served as a control, and only 0.2 ml of normal saline solution was given 24 h preoperatively. One eye of each rabbit was randomly selected for the experiment, while the other eye served as a control. The bleb lasted 30.9 $pM 15.7 days in Group I, 16.0 $pM 6.4 days in Group II, 15.5 $pM 6.5 days in Group III, and 2.3 $pM 0.7 days in Group IV. The IOP lowering effect was parallel to bleb formation. The results demonstrate that a subconjunctival mitomycin-C injection given 24 h before a filtering operation is more effective in prolonging the filtering effect produced by the THC:YAG laser than one given postoperatively.