Stab incision mitomycin C-assisted rapid trabeculectomy: A 'SMART' trabeculectomy alternative

Area of Science:

• Ophthalmology
• Surgical Innovation
• Glaucoma Management

Background:

• Glaucoma surgery, particularly trabeculectomy, aims to reduce intraocular pressure (IOP).
• Traditional trabeculectomy involves significant surgical time and tissue manipulation.
• There is a need for modified techniques that are faster and less invasive.

Purpose of the Study:

• To introduce and evaluate a new modified trabeculectomy technique: stab incision mitomycin C (MMC)-assisted rapid trabeculectomy (SMART).
• To assess the safety, efficacy, and surgical characteristics of the SMART technique compared to classic trabeculectomy.

Main Methods:

• The SMART technique involves subconjunctival MMC injection, a small conjunctival opening, a stab incision into the anterior chamber, and double punch excision.
• A total of 41 eyes with glaucoma underwent the SMART procedure.
• Surgical time, tissue manipulation, intraocular pressure (IOP), and medication usage were recorded.

Main Results:

• The mean preoperative IOP was 23.8 mmHg, reduced to 11 mmHg one year post-surgery (a reduction of 12.8 mmHg).
• Mean medication use decreased from 3.3 to 0.7 post-surgery.
• The mean follow-up was 27.6 months, with all eyes maintaining IOP <15 mmHg and experiencing few minor complications.

Conclusions:

• SMART trabeculectomy is a safe, quick, and effective alternative to classic trabeculectomy.
• The technique requires less surgical time and tissue manipulation.
• Wound modulation with MMC in the SMART technique leads to significant IOP reduction and sustained control.