[Trabeculectomy with mitomycin C supplemented with cross-linking hyaluronic acid: a pilot study]

Besides antimetabolites (5-fluorouracil [5-FU]), cytostatic agents (mitomycin C [MMC]) and topical steroids, various substances have been used for the modulation of wound healing in filtering glaucoma surgery. The anti-inflammatory effects of hyaluronic acid and its space-occupying properties may be useful in filtering as well as in non-filtering glaucoma surgery.

In a non-randomised pilot study cross-linking hyaluronic acid (HealaFlow) was injected below the scleral flap and under the conjunctiva in 66 patients undergoing filtering surgery. All 66 patients (age 70.3 +/- 9.6 years; 41 - 88) had a standard trabeculectomy with MMC (0.25 % for 3 min). Glaucoma diagnoses were pseudoexfoliation glaucoma in 32 cases, primary open-angle glaucoma in 32 cases, ICE syndrome in one case and Axenfeld/Rieger in one case.

Intraocular pressure (IOP) levels were reduced from preoperatively 22.3 +/- 6.0 mmHg (12 - 40) with 2.7 +/- 1.0 (1 - 4) IOP-lowering medications to 11.9 +/- 5.1 mmHg (2 - 26) after 29.8 +/- 12.4 weeks (13 - 56) follow-up. Fifty-nine of the 66 patients (89.4 %) did not need IOP lowering medications at the end of the follow-up, 52 / 66 patients (78.8 %) had an IOP < or = 14 mmHg, 47 of these 52 patients (90.4 %) without medication. Argon laser suturolysis had to be performed in 28 / 66 eyes (42.4 %), 40 / 66 patients (60.6 %) required 1 - 4 subconjunctival injections of 15 mg (0.3 mL) 5-fluorouracil.

Injections of HealaFlow below the scleral flap and the conjunctiva at the end of the surgery along with intraoperative application of MMC showed promising IOP-lowering effects in trabeculectomy. A prospective randomised study is required to confirm these preliminary results.