Low-dose and high-dose mitomycin trabeculectomy as an initial surgery in primary open-angle glaucoma

Area of Science:

• Ophthalmology
• Glaucoma Research
• Surgical Innovation

Background:

• Trabeculectomy is a common surgical procedure for glaucoma.
• Mitomycin-C is an antifibrotic agent used as an adjunct to trabeculectomy.
• Determining the optimal mitomycin-C dosage is crucial for balancing efficacy and safety.

Purpose of the Study:

• To determine the optimal intraoperative regimen of mitomycin-C as an adjunct to trabeculectomy.
• To compare the efficacy and safety of two different mitomycin-C concentrations (0.2 mg vs. 0.02 mg).

Main Methods:

• A randomized controlled trial involving 11 patients (22 eyes) with primary open-angle glaucoma.
• One eye per patient received 0.2 mg mitomycin-C, while the fellow eye received 0.02 mg mitomycin-C, applied for 5 minutes during trabeculectomy.
• Follow-up ranged from 6 to 17 months.

Main Results:

• Successful intraocular pressure control was achieved in 100% of eyes treated with 0.2 mg mitomycin-C versus 63.6% with 0.02 mg.
• Transient hypotony maculopathy and cataract progression occurred exclusively in the 0.2 mg group (18% each).
• Other complications were similar between the two dosage groups.

Conclusions:

• The 0.2 mg dose of mitomycin-C demonstrated superior efficacy in controlling intraocular pressure compared to the 0.02 mg dose.
• The higher dose was associated with specific adverse events, including hypotony maculopathy and cataract progression.
• The findings suggest that an intermediate dose of mitomycin-C may represent the most appropriate regimen for primary glaucoma surgery.