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The effect of low-and high-dose adjunctive mitomycin C in trabeculectomy
1Department of Ophthalmology, College of Medicine, Seoul National University, Korea.
Abstract:
To compare the effects of three different concentrations of mitomycin C (MMC) as an adjunct therapy to trabeculectomy, we reviewed 26 patients (36 eyes) who underwent trabeculectomy in which MMC was applied intraoperatively. The time of application was 5 minutes, and the concentration of MMC was 0.1 mg/ml (n = 10), 0.2 mg/ml (n = 17) and 0.4 mg/ml (n = 9), respectively. Complete success was defined by intraocular pressure (IOP) of 21 mmHg or less without medication at postoperative 3 months. There was no statistical difference among the three groups in mean age of patients, preoperative IOPs, and the numbers of premedication. The mean IOP at postoperative 3 months was significantly lower in the 0.4 mg/ml group (10.4 +/- 5.5 mmHg) than in the 0.2 mg/ml group (16.1 +/- 4.7 mmHg) (p < 0.05). The complete success rate in the 0.4 mg/ml group was 100%, which was significantly higher than the rate of 40% obtained with the 0.1 mg/ml group (p < 0.05), but was not significantly different to the rate of 70.6% in the 0.2 mg/ml group (p > 0.05). There was no statistical difference among the three groups in the success rate regardless of medication, and the size and longevity of the filtering bleb. Postoperative hypotony was noted in two eyes of the 0.4 mg/ml group.
Insights
Higher concentrations of mitomycin C (MMC) improve trabeculectomy success rates. The 0.4 mg/ml MMC group showed significantly lower intraocular pressure (IOP) and higher complete success rates compared to lower concentrations.
Area of Science:
- Ophthalmology
- Surgical Innovation
Background:
- Trabeculectomy is a common glaucoma surgery.
- Mitomycin C (MMC) is used as an adjunct to prevent scarring and improve success rates.
- Optimal MMC concentration for trabeculectomy remains under investigation.
Purpose of the Study:
- To compare the efficacy of three different concentrations of mitomycin C (MMC) as an adjunct therapy in trabeculectomy.
- To evaluate the impact of MMC concentration on intraocular pressure (IOP) and surgical success.
Main Methods:
- Retrospective review of 26 patients (36 eyes) undergoing trabeculectomy with intraoperative MMC application.
- MMC concentrations tested: 0.1 mg/ml, 0.2 mg/ml, and 0.4 mg/ml (5-minute application).
- Success defined as IOP ≤ 21 mmHg without medication at 3 months post-surgery.
Main Results:
- The 0.4 mg/ml MMC group achieved significantly lower mean postoperative IOP (10.4 mmHg) compared to the 0.2 mg/ml group (16.1 mmHg).
- Complete success rate was 100% in the 0.4 mg/ml group, significantly higher than the 0.1 mg/ml group (40%).
- No significant differences in success rates regardless of medication, filtering bleb size, or longevity were observed across groups. Two cases of hypotony occurred in the 0.4 mg/ml group.
Conclusions:
- A 0.4 mg/ml concentration of mitomycin C (MMC) appears to be more effective in lowering IOP after trabeculectomy compared to 0.2 mg/ml.
- Higher MMC concentrations may enhance surgical success rates in trabeculectomy, though potential for hypotony should be monitored.
- Further research is warranted to optimize MMC concentration and application protocols for glaucoma surgery.