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Simultaneous subconjunctival and subscleral mitomycin-C application in trabeculectomy
F El Sayyad1, M Belmekki, M Helal
1El-Maghraby Eye Hospital, Jeddah, Saudi Arabia.
Objective:
To establish the efficacy and safety of simultaneous subconjunctival and subscleral application of mitomycin-C in trabeculectomy.
Design:
A prospective, randomized study.
Participants:
Sixty-eight patients (68 eyes) with refractory glaucomas were included in the study.
Intervention:
Eyes were randomly assigned to receive intraoperative mitomycin-C (0.3 mg/ml) applied under the conjunctival flap (group 1), scleral flap (group 2), or under both flaps (group 3).
Main Outcome Measures:
Mean intraocular pressure (IOP), postoperative medications, visual acuity, filtering bleb appearance, and complications.
Results:
There was a significant difference in IOP at 6, 9, and 12 months after surgery among the three groups (P = 0.021, 0.026, and 0.033, respectively ANOVA). At 12 months, the mean IOP in group 3 was 9.8+/-3.7 mm Hg compared with 13.4+/-5.5 mm Hg in group 2. (P = 0.015) and 12.4+/-4.4 mm Hg in group 1 (P = 0.039). Success rate (21 mm Hg or less), number of antiglaucoma medications, and complications showed no statistical significant difference between the three groups at each postoperative visit.
Conclusions:
Mitomycin-C applied under the scleral flap may have an additional beneficial effect when combined with simultaneous subconjunctival exposure.