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The effects of intraoperative mitomycin-C or 5-fluorouracil on glaucoma filtering surgery
1Department of Ophthalmology, College of Medicine, Seoul National University, Korea.
Abstract:
We compared the success rate of filtering surgery of a single 5-minute intraoperative application of mitomycin-C (MMC) or 5-fluorouracil (5-FU). Animal experiment and clinical study were done. In animal study, thirty pigmented rabbits (60 eyes) weighing 2.0 to 2.5 Kg were enrolled. We divided into 4 groups, such as BSS, 5-FU 50 mg/ml, MMC 0.2 mg/ml and MMC 0.4 mg/ml subconjunctival soaked group. Each group consisted of 15 eyes. In each group, 10 eyes was for examination of bleb survival and complications, 3 eyes for light microscopic examination and 2 eyes for electron microscopic examination. Bleb was survived 6.1 days (3 to 13 days) for BSS treated group, 16.3 days (9 to 23 days) for 5-FU 50mg/ml treated group, 32.7 days (17 to 55 days) in MMC 0.2 mg/ml treated group, and 64.4 days (49 to 84 days) in MMC 0.4 mg/ml treated group. Duration of bleb survival was significantly prolonged in 5-FU, MMC 0.2 mg/ml and MMC 0.4 mg/ml group respectively. In clinical study, fifty-five eyes of 40 patients were enrolled. 29 eyes of 21 patients were treated with MMC 0.2 mg/ml and 26 eyes of 19 patients were treated with 5-FU 50 mg/ml. The success rate was 89.7% in MMC 0.2 mg/ml treated group and 84.6% in 5-FU 50 mg/ml treated group at postoperative 3 months, and postoperative 6 months 89.7% in MMC 0.2 mg/ml treated group and 76.9% in 5-FU 50 mg/ml treated group. There was no statistical significance at postoperative 3 months (P > 0.05), but statistical significance at postoperative 6 months (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Mitomycin-C (MMC) and 5-fluorouracil (5-FU) both enhance filtering surgery success. MMC demonstrated superior bleb survival and efficacy in clinical trials compared to 5-FU at six months post-operation.
Area of Science:
- Ophthalmology
- Surgical Innovation
- Pharmacological Adjuncts
Background:
- Filtering surgery is a key treatment for glaucoma.
- Optimizing surgical outcomes requires effective adjuncts.
- Mitomycin-C (MMC) and 5-fluorouracil (5-FU) are commonly used antimetabolites.
Purpose of the Study:
- To compare the efficacy of intraoperative mitomycin-C (MMC) versus 5-fluorouracil (5-FU) in enhancing filtering surgery success.
- To evaluate bleb survival and complication rates in animal models.
- To assess the long-term clinical success rates of MMC and 5-FU in glaucoma patients.
Main Methods:
- Animal study: Thirty rabbits underwent subconjunctival soaking with balanced salt solution (BSS), 5-FU (50 mg/ml), MMC (0.2 mg/ml), or MMC (0.4 mg/ml).
- Bleb survival, light, and electron microscopy were assessed.
- Clinical study: Fifty-five patients received either MMC (0.2 mg/ml) or 5-FU (50 mg/ml) during filtering surgery.
Main Results:
- Animal study: MMC significantly prolonged bleb survival, with the 0.4 mg/ml concentration showing the longest duration (64.4 days) compared to 5-FU (16.3 days) and BSS (6.1 days).
- Clinical study: At 6 months post-operation, MMC (0.2 mg/ml) showed a higher success rate (89.7%) compared to 5-FU (50 mg/ml) (76.9%), with statistical significance (P < 0.05).
- No significant difference in success rates was observed at 3 months post-operation.
Conclusions:
- Intraoperative application of MMC and 5-FU improves filtering surgery outcomes.
- MMC, particularly at a 0.2 mg/ml concentration, offers superior and statistically significant long-term efficacy compared to 5-FU in enhancing filtering surgery success.
- Both agents were associated with bleb survival and complication management.