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Mitomycin C in higher risk trabeculectomy: a prospective comparison of 0.2- to 0.4-mg/cc doses
S P Sanders1, L B Cantor, A A Dobler
1Department of Ophthalmology, University of Kentucky, Lexington 40536, USA.
Purpose:
This randomized, masked, prospective study was conducted to compare the outcome of filtering surgery using doses of 0.2 mg/cc or 0.4 mg/cc of mitomycin C (MMC) in eyes that were at higher risk from previous conjunctival incisional surgery.
Methods:
Eyes of 50 consecutive patients with primary open-angle, pseudoexfoliation, or pigmentary glaucoma requiring trabeculectomy who had previously undergone either limbal cataract surgery or trabeculectomy were enrolled. Patients received an intraoperative dose of either 0.2 or 0.4 mg/cc MMC for 2 minutes (n = 25 in each study group). Intraocular pressure (IOP), logMAR visual acuity, and complications were monitored at regular intervals for 1 year. Unpaired student t tests were used to compare percent decrease in IOP in both study groups at each interval.
Results:
The percent decrease in IOP was not significantly different between groups at 1 day, 1 week, 1 month, 3 months, 6 months, or 1 year after surgery. LogMAR visual acuity was not significantly different between groups at 1 month, 6 months, or 1 year. Treatment failure occurred in seven patients in the 0.2 mg/cc group (28%) and seven patients in the 0.4 mg/cc group (29.2%). Postoperative hypotony, choroidal effusions and hemorrhages, and wound leaks occurred in both groups, but occurred more often in the group receiving 0.4 mg/cc MMC.
Conclusion:
Filtering surgery performed on higher risk eyes was as effective using a lower dose (0.2 mg/cc) of MMC as that using a higher dose (0.4 mg/cc). Incidence of complications and treatment failures was slightly higher in the group receiving high-dose MMC.
Insights
A lower dose of mitomycin C (MMC) is as effective as a higher dose for filtering surgery in high-risk glaucoma patients. The 0.2 mg/cc dose showed similar outcomes with fewer complications than the 0.4 mg/cc dose.
Area of Science:
- Ophthalmology
- Glaucoma Surgery
- Mitomycin C Applications
Background:
- Filtering surgery is a common treatment for glaucoma.
- Previous incisional surgery increases risks for filtering procedures.
- Mitomycin C (MMC) is used to enhance surgical outcomes.
Purpose of the Study:
- To compare the efficacy and safety of two doses of mitomycin C (MMC) during filtering surgery.
- To evaluate outcomes in high-risk glaucoma patients previously treated with incisional surgery.
Main Methods:
- A randomized, masked, prospective study enrolled 50 high-risk glaucoma patients.
- Patients received either 0.2 mg/cc or 0.4 mg/cc of MMC intraoperatively.
- Intraocular pressure, visual acuity, and complications were monitored for one year.
Main Results:
- No significant difference in intraocular pressure reduction or visual acuity between the 0.2 mg/cc and 0.4 mg/cc MMC groups.
- Treatment failure rates were similar in both groups (28% vs. 29.2%).
- Higher rates of hypotony, choroidal effusions/hemorrhages, and wound leaks were observed with the 0.4 mg/cc MMC dose.
Conclusions:
- Lower-dose (0.2 mg/cc) mitomycin C (MMC) is as effective as higher-dose (0.4 mg/cc) MMC for filtering surgery in high-risk eyes.
- The higher MMC dose was associated with a slightly increased incidence of complications and treatment failures.