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Low-dose postoperative transconjunctival application of mitomycin C in rabbit trabeculectomy
S M El-Harazi1, R M Feldman, G Villanueva
1Department of Ophthalmology and Visual Science, University of Texas Health Science Center, Houston, USA.
Purpose:
Mitomycin C (MMC) is commonly administered during filtering surgery to enhance the success of the procedure. Unfortunately, the increased success rate is associated with complications, including late bleb leaks, endophthalmitis, and ciliary epithelial toxicity. The purpose of this study was to investigate a safe and effective dose regimen for MMC to reduce incidence of those complications.
Methods:
Trabeculectomy was performed in 36 rabbits. MMC was applied only during surgery, only one day after surgery, or once daily after surgery for 3 days at lower concentrations. Balanced salt solution (BSS) was administered during surgery to one group as a placebo. The time to bleb failure was determined and the eyes were evaluated histopathologically. Success and toxicity were compared for the different treatment groups.
Results:
The mean time until trabeculectomy failure was 2.83 days for the placebo group, 6.33 days with administration of MMC 0.5 mg/mL during surgery, 7.83 days with administration of MMC 0.5 mg/mL once after surgery, and 11, 9, and 4.83 days with administration of MMC 0.1 mg/mL, 0.05 mg/mL, or 0.025 mg/mL, respectively, once a day for 3 consecutive days. On electron microscopic examination of the ciliary epithelium, toxic effects were greatest with MMC concentrations of 0.5 mg/mL and were less with lower concentrations.
Conclusion:
The effect of MMC on trabeculectomy survival was dependent on both the concentration and the method of administration. Lower concentrations with multiple postoperative administrations were as effective as but caused less ciliary body toxicity than intraoperative administration of higher concentrations.
Insights
Lower concentrations of Mitomycin C (MMC) administered post-surgery are as effective as higher intraoperative doses for trabeculectomy success but with reduced toxicity. This finding offers a safer approach to glaucoma surgery. Keywords: Mitomycin C, trabeculectomy, glaucoma surgery, drug toxicity.
Area of Science:
- Ophthalmology
- Surgical Innovation
- Pharmacology
Background:
- Mitomycin C (MMC) enhances filtering surgery success but causes complications like bleb leaks and ciliary toxicity.
- Optimizing MMC dosage is crucial for balancing efficacy and safety in glaucoma treatment.
Purpose of the Study:
- To investigate optimal Mitomycin C (MMC) dose regimens for trabeculectomy.
- To reduce MMC-associated complications, including late bleb leaks and ciliary epithelial toxicity.
Main Methods:
- Trabeculectomy was performed on 36 rabbits.
- MMC was administered intraoperatively, one day post-surgery, or daily for 3 days post-surgery at varying concentrations.
- Bleb failure time and histopathological toxicity were assessed.
Main Results:
- Trabeculectomy failure times varied: 2.83 days (placebo), 6.33 days (0.5 mg/mL intraoperative), 7.83 days (0.5 mg/mL once post-op).
- Lower concentrations (0.1, 0.05, 0.025 mg/mL) administered daily for 3 days post-op resulted in longer failure times (11, 9, 4.83 days).
- Ciliary epithelial toxicity was highest with 0.5 mg/mL MMC and decreased with lower concentrations.
Conclusions:
- MMC's effect on trabeculectomy survival depends on concentration and administration timing.
- Lower MMC concentrations with multiple postoperative administrations are as effective as higher intraoperative doses.
- Postoperative MMC administration at lower doses significantly reduces ciliary body toxicity.