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Baerveldt Aqueous Shunt with or without Mitomycin C Augmentation: A Retrospective Comparison Study
Ricardo De Sousa Peixoto1, Amrita Saravananan2, Harathy Selvan2
1University Hospitals Derby and Burton, Derby, United Kingdom; Birmingham Midlands Eye Centre, Birmingham, United Kingdom.
Objective:
To evaluate if intraoperative mitomycin C (MMC) influences the success of Baerveldt aqueous shunts.
Design:
Retrospective comparative case series.
Participants:
The study population consisted of 88 patients. Fifty-five received intraoperative MMC and 33 did not (controls).
Methods:
The medical records of consecutive patients who underwent standalone Baerveldt aqueous shunts at Birmingham Midland Eye Centre, United Kingdom, were retrospectively reviewed. Patients in the MMC group received 0.2 to 0.4 mg/mL of MMC intraoperatively whereas controls did not.
Main Outcome Measures:
Primary outcome was survival, which was defined as an intraocular pressure (IOP) > 6 mmHg and ≤ 21 mmHg or ≤ 18 mmHg and > 20% IOP reduction from baseline. Further analysis of patients who required medications (qualified) or no medications (complete) was undertaken. Secondary outcomes were IOP, number of glaucoma medications, complications, intraluminal ripcord removal (IRR), and interventions.
Results:
Average follow-up was 4.7 ± 1.4 years. At year 5, complete success with the ≤ 21 mmHg threshold was significantly higher in MMC vs controls (39.3% vs 17.8%; log rank P = 0.016). Final complete success with the ≤ 18 mmHg threshold was higher in patients with MMC shunts vs controls (38% vs 15.6%; log rank P = 0.0042). Qualified success was not different between patients with MMC shunts and controls with ≤ 21 mmHg (82% vs 93%; log rank P = 0.29) and ≤ 18 mmHg thresholds (70.3% vs 79.3%; log rank P = 0.44). Uveitic patients were also more likely to achieve complete success at both 21 and 18 mmHg thresholds among the patients receiving MMC compared with controls. Mitomycin C was correlated with lower number of medications between month 3 and year 2 post operatively (P < 0.001) and with a lower rate of IRR at all timepoints (P < 0.001). There were no significant differences in the incidence of prolonged hypotony, although MMC cases had higher transient hypotony at year 1 (P = 0.049).
Conclusions:
Mitomycin C provides a significant advantage in Baerveldt aqueous shunt survival when considering medication-free success but not in qualified success. Control patients required more medications to control IOP. This study suggests that intraoperative MMC augmentation of Baerveldt aqueous shunt surgery may be advantageous in achieving IOP control without the need for medication but that it may be associated with more transient hypotony episodes.
Financial Disclosure(S):
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Insights
Intraoperative mitomycin C (MMC) significantly improves Baerveldt aqueous shunt survival without medications, but does not affect qualified success rates. MMC use correlated with fewer medications and less intraluminal ripcord removal.
Area of Science:
- Ophthalmology
- Glaucoma Surgery
- Surgical Adjuncts
Background:
- Baerveldt aqueous shunts are used to manage glaucoma.
- Intraoperative mitomycin C (MMC) is a potential adjunct to enhance surgical success.
- The efficacy of MMC in Baerveldt shunt surgery requires further evaluation.
Purpose of the Study:
- To determine if intraoperative mitomycin C (MMC) impacts the success of Baerveldt aqueous shunts.
- To compare outcomes between patients receiving MMC and a control group.
Main Methods:
- Retrospective comparative case series of 88 patients undergoing Baerveldt shunts.
- 55 patients received intraoperative MMC (0.2-0.4 mg/mL), 33 did not.
- Primary outcome: intraocular pressure (IOP) control (≤21 mmHg or ≤18 mmHg) with or without medications.
Main Results:
- Complete success (medication-free IOP control) was significantly higher with MMC at 5 years (39.3% vs 17.8% for ≤21 mmHg; 38% vs 15.6% for ≤18 mmHg).
- Qualified success (IOP control with medications) showed no significant difference between groups.
- MMC use correlated with fewer glaucoma medications and lower rates of intraluminal ripcord removal (IRR).
- Transient hypotony was more common with MMC, but prolonged hypotony was not significantly different.
Conclusions:
- Intraoperative MMC offers a significant advantage for medication-free Baerveldt shunt success.
- MMC use may reduce the need for glaucoma medications post-surgery.
- While associated with transient hypotony, MMC augmentation appears beneficial for achieving sustained IOP control.
