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[Clinical experiences and results of application of mitomycin C in trabeculectomy]
Thomas Laube1, Birgit Ritters, Michael Selbach
1Abteilung für Erkrankungen des vorderen Augenabschnitts, Universitätsklinikum Essen. thomas.laube@uni-essen.de
Background:
Mitomycin C (MMC) used as an additive agent in glaucoma surgery has been shown to improve the postoperative results of intraocular pressure (IOP), but may also lead to higher incidences of postoperative wound healing disorders and of hypotonia with choroidal detachment. In this retrospective study the levels of IOP, the incidence of complications and changes of the visual acuity (VA) were monitored.
Methods:
A trabeculectomy was performed on 70 eyes (57 patients). During surgery MMC was applied in three different concentrations: 0.1 mg/ml MMC (n = 8), 0.2 mg/ml MMC (n = 53) and 0.4 mg/ml MMC (n = 9) for 2.5 minutes, respectively. Patients were reexamined one day, and at 3 and 12 months after surgery.
Results:
IOP was lowered with high statistical significance at all dates of control examination no matter what concentration of MMC had been used. At the time of discharge from hospital the success rate without additional topical glaucoma medication was 96 %, 78 % after 3 months and 68 % after 12 months. With glaucoma medication the success rate was 92 % after 3 months and 85 % after 12 months. Frequent complications were choroidal detachments in 40 % and hypotonia in 21 % of all cases. The VA did not change significantly during the follow-up period.
Conclusions:
This study underlines the efficacy of MMC as an additive agent in glaucoma surgery. However, considerable complications may be expected. Considering the effectiveness and the complication rate a concentration of 0.2 mg/ml MMC should be preferred.
Insights
Mitomycin C effectively lowers intraocular pressure in glaucoma surgery but carries risks. A concentration of 0.2 mg/ml is recommended to balance efficacy and complications.
Area of Science:
- Ophthalmology
- Surgical Innovation
- Pharmacology
Context:
- Glaucoma surgery aims to reduce intraocular pressure (IOP).
- Mitomycin C (MMC) is an adjunctive agent used in glaucoma surgery to improve outcomes.
- Potential complications include wound healing issues and hypotony.
Purpose:
- To evaluate the efficacy and safety of Mitomycin C (MMC) in trabeculectomy for glaucoma.
- To compare different concentrations of MMC (0.1, 0.2, and 0.4 mg/ml) regarding IOP reduction and complication rates.
- To assess the long-term impact on visual acuity (VA).
Summary:
- Trabeculectomy with MMC demonstrated statistically significant IOP reduction across all tested concentrations.
- Success rates varied: 96% at discharge, 68% at 12 months without medication, and 85% at 12 months with medication.
- Common complications included choroidal detachments (40%) and hypotony (21%), while VA remained stable.
Impact:
- Mitomycin C is effective in lowering IOP in glaucoma surgery.
- A concentration of 0.2 mg/ml is suggested as optimal, balancing effectiveness with a manageable complication profile.
- Further research into mitigating MMC-related complications is warranted.
