Transconjunctival penetration of mitomycin C

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Pharmacology

Background:

• Trabeculectomy is a common glaucoma surgery.
• Mitomycin C (MMC) is used to enhance surgical outcomes by inhibiting fibroblast proliferation.
• Current MMC application methods include subconjunctival or subscleral injection.

Purpose of the Study:

• To determine the transconjunctival penetration of mitomycin C (MMC) into Tenon's tissue.
• To evaluate MMC concentration in Tenon's tissue after topical application on the intact conjunctiva prior to trabeculectomy.

Main Methods:

• A case series involving 41 eyes of 41 patients undergoing trabeculectomy.
• Topical application of MMC (0.4 mg/ml for 3 minutes) to the intact conjunctiva.
• Excision and analysis of Tenon's capsule tissue using high-performance liquid chromatography (HPLC) to quantify MMC concentration.

Main Results:

• The average MMC concentration in Tenon's tissue was 18.67+/-32.36 x 10(-6) moles/kg.
• In 87.80% of patients, MMC concentration exceeded the 2 x 10(-6) moles/kg threshold required to inhibit conjunctival fibroblasts.
• MMC demonstrated significant penetration into subconjunctival tissue.

Conclusions:

• Topical application of MMC over the conjunctiva allows penetration into Tenon's tissue.
• This method may serve as a viable alternative to subconjunctival or subscleral MMC application.
• It could be beneficial as an adjunct therapy for improving outcomes in trabeculectomy and managing failing blebs.