Noncontact Conjunctiva: A Better Mitomycin C Application Site for Trabeculectomy

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Surgical Complications

Background:

• Bleb scarring is a primary complication following trabeculectomy.
• Mitomycin C (MMC) application site may influence trabeculectomy outcomes.
• Optimizing MMC application is crucial for surgical success and safety.

Purpose of the Study:

• To compare the efficacy and safety of two distinct mitomycin C (MMC) application sites in trabeculectomy.
• To evaluate intraocular pressure (IOP) lowering and complication rates based on MMC placement.
• To determine the optimal MMC application technique for trabeculectomy.

Main Methods:

• Retrospective analysis of 177 eyes undergoing trabeculectomy with MMC.
• Group 1: MMC applied under scleral flap, avoiding Tenon's capsule (70 eyes).
• Group 2: MMC applied under scleral flap, covering Tenon's capsule (107 eyes).
• Outcomes assessed: IOP, BCVA, success rates, and complications.

Main Results:

• Both MMC application methods achieved significant IOP reduction.
• No significant difference in IOP lowering or BCVA changes between groups.
• Thin-walled blebs and hypotony occurred more frequently when Tenon's capsule was covered by MMC (P=0.008, P=0.012).
• No significant differences in BCVA or other complications were observed.

Conclusions:

• Subconjunctival MMC application without Tenon's capsule contact yields comparable IOP reduction to the covered technique.
• Avoiding Tenon's capsule contact with MMC reduces the risk of thin-walled blebs and hypotony.
• Subconjunctival MMC application is a safer approach during trabeculectomy.