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The effect of reducing the exposure time of mitomycin C in glaucoma filtering surgery
G S Mégevand1, J F Salmon, R P Scholtz
1Department of Ophthalmology, Groote Schuur Hospital, Cape Town, South Africa.
Background:
The use of adjunctive intraoperative mitomycin C has considerably improved the success rate of glaucoma filtering surgery. However, the ideal concentration and exposure time of mitomycin C is unknown. The purpose of this study is to determine whether a satisfactory surgical outcome can be achieved with a lower incidence of adverse side effects by using a shorter exposure time of mitomycin C than has been recommended previously.
Methods:
Twenty-five eyes of 25 consecutive patients who were considered to be at high risk for surgical failure because of their age (< 55 years), previous failure of trabeculectomy, previous cataract surgery, or traumatic glaucoma received a single intraoperative application of mitomycin C (0.2 mg/ml for 2 minutes). They were case-matched with a group of 48 consecutive patients who received a single intraoperative application of mitomycin C (0.2 mg/ml for 5 minutes) by using age, race, type of refractory glaucoma, and preoperative intraocular pressure (IOP) as variables.
Results:
Eighteen months after surgery, 22 (88%) patients in the 2-minute group and 21 (84%) patients in the 5-minute group had an IOP less than 21 mmHg with or without treatment. No significant differences were found in the complication rate: in 2 (8%) of 25 eyes of the 2-minute group, chronic hypotony developed compared with 3 (12%) of 25 eyes in the 5-minute group. Hypotony-related maculopathy developed in one eye in the 5-minute group. A cystic bleb was found in 15 (60%) eyes in the 2-minute group compared with 19 (76%) eyes in the 5-minute group, although this difference was not statistically significant. Two (8%) eyes in the 2-minute group and one eye (4%) in the 5-minute group had a bleb-related infection. In one (4%) patient in each group, late severe endophthalmitis developed.
Conclusion:
These results suggest that a 2-minute intraoperative application of 0.2 mg/ml mitomycin C is as effective as a 5-minute exposure, but the complication rate remains unaltered.
Insights
A shorter 2-minute application of mitomycin C during glaucoma surgery is as effective as the standard 5-minute exposure. This finding suggests a potential to reduce side effects in glaucoma filtering surgery without compromising outcomes.
Area of Science:
- Ophthalmology
- Surgical Innovation
- Glaucoma Management
Background:
- Intraoperative mitomycin C (MMC) enhances glaucoma filtering surgery success rates.
- Optimal MMC concentration and exposure time remain undetermined.
- This study investigates if a reduced MMC exposure time can maintain efficacy while minimizing adverse events.
Purpose of the Study:
- To evaluate the efficacy and safety of a 2-minute intraoperative mitomycin C (MMC) application compared to a 5-minute application in high-risk glaucoma patients.
- To determine if a shorter MMC exposure time can achieve satisfactory surgical outcomes with a lower incidence of complications.
Main Methods:
- A case-matched study comparing 25 high-risk glaucoma patients receiving 2-minute MMC (0.2 mg/ml) with 48 patients receiving 5-minute MMC (0.2 mg/ml).
- Patient matching was based on age, race, glaucoma type, and preoperative intraocular pressure (IOP).
- Surgical outcomes and complication rates were assessed 18 months post-surgery.
Main Results:
- Both 2-minute and 5-minute MMC groups achieved successful IOP control (< 21 mmHg) in 88% and 84% of patients, respectively.
- No significant differences in complication rates, including chronic hypotony (8% vs. 12%) and cystic blebs (60% vs. 76%), were observed.
- Rates of bleb-related infections and endophthalmitis were low and comparable between the two groups.
Conclusions:
- A 2-minute intraoperative application of 0.2 mg/ml mitomycin C is as effective as a 5-minute exposure for glaucoma filtering surgery.
- The complication rate appears unaltered by the reduced exposure time.
- Shorter MMC exposure may offer a viable alternative in glaucoma surgery.