Intraoperative mitomycin versus postoperative 5-fluorouracil in high-risk glaucoma filtering surgery

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Pharmacology

Background:

• Glaucoma filtering surgery aims to reduce intraocular pressure (IOP).
• High-risk patients often experience failure of standard filtering surgery.
• Subconjunctival antifibrotic agents like 5-fluorouracil (5-FU) and mitomycin (MMC) are used to enhance surgical success.

Purpose of the Study:

• To compare the efficacy and safety of intraoperative subconjunctival mitomycin (MMC) versus postoperative subconjunctival 5-fluorouracil (5-FU) injections in high-risk glaucoma filtering surgery.
• To evaluate the impact on intraocular pressure, medication requirements, and ocular toxicity.

Main Methods:

• A randomized clinical trial was conducted.
• 19 eyes received postoperative 5-FU injections.
• 20 eyes received a single intraoperative MMC application at the filtering site.

Main Results:

• Six months post-surgery, MMC-treated eyes had lower mean IOP (10.9 mmHg) compared to 5-FU-treated eyes (14.2 mmHg; P=0.08).
• A significantly higher proportion of MMC-treated eyes achieved IOP ≤12 mmHg (60.0%) versus 5-FU-treated eyes (21.1%; P=0.03).
• MMC-treated eyes required fewer IOP-lowering medications (0.3) than 5-FU-treated eyes (1.1; P=0.01) and showed no drug-induced corneal defects, unlike 5-FU-treated eyes (P=0.0004).

Conclusions:

• Intraoperative subconjunctival MMC is a potentially viable alternative to postoperative 5-FU for high-risk glaucoma filtering surgery.
• MMC demonstrated superior IOP control, reduced medication dependence, and improved ocular safety profile.
• Further research may confirm MMC's role in optimizing outcomes for glaucoma patients undergoing filtration surgery.