Intraoperative mitomycin C for nonpenetrating glaucoma surgery: a systematic review and meta-analysis

To evaluate the efficacy and tolerability between nonpenetrating glaucoma surgery with (NPGS-MMC) and without (NPGS-noMMC) intraoperative mitomycin C application in the treatment of patients with open angle glaucoma.

Pertinent studies were selected through extensive searches of the Cochrane Library, PubMed, Embase, and Chinese Biomedicine Database. Eight controlled clinical trials meeting the predefined criteria were systematically reviewed by meta-analysis. The main outcome measures were percentage intraocular pressure reduction and complete success rate. The pooled estimates were carried out in RevMan version 5.0 software.

The weighted mean differences of the percentage intraocular pressure reduction when comparing NPGS-MMC with NPGS-noMMC were 5.24% (95% confidence intervals: -3.24-13.72) at 6 months, 8.31% (4.33 to 12.30) at 12 months, 9.56% (4.88 to 14.24) at 24 months, and 14.45% (9.03 to 19.88) at 36 months. NPGS-MMC was associated with significant greater complete success rates compared with NPGS-noMMC, with a pooled risk ratio being 1.16 (1.05 to 1.27) at 6 months, 1.20 (1.05 to 1.38) at 12 months, 1.30 (1.05 to 1.61) at 24 months, and 1.36 (1.06 to 1.73) at 36 months. Intraoperative MMC was not associated with any drug-induced complications.

The use of intraoperative MMC is a safe and effective additional step during nonpenetrating filtering surgery.