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Low-dose mitomycin C trabeculectomy in patients with advanced glaucoma
V P Costa1, P E Comegno, J P Vasconcelos
1Department of Ophthalmology, University of Campinas (UNICAMP), Brazil.
Journal of Glaucoma
|June 1, 1996
Summary
Low-dose intraoperative mitomycin C significantly reduced intraocular pressure in primary trabeculectomy patients. This glaucoma treatment offers a viable alternative for advanced cases, despite some short-term side effects.
Area of Science:
- Ophthalmology
- Glaucoma Research
- Surgical Innovation
Background:
- Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness worldwide.
- Trabeculectomy remains a cornerstone surgical treatment for advanced glaucoma.
- Optimizing surgical outcomes and minimizing complications are critical in glaucoma management.
Purpose of the Study:
- To evaluate the efficacy and safety of low-dose (0.2 mg/ml) intraoperative mitomycin C during primary trabeculectomy.
- To determine if mitomycin C improves intraocular pressure control in patients with advanced POAG.
- To assess the complication profile associated with low-dose mitomycin C in this surgical context.
Main Methods:
- A randomized controlled trial involving 28 eyes of 28 patients with advanced POAG undergoing primary trabeculectomy.
- Patients were randomized to receive either intraoperative mitomycin C (0.2 mg/ml) or a saline control for 3 minutes.
- Intraocular pressure (IOP) was monitored at multiple time points postoperatively up to the final follow-up visit.
Main Results:
- The mitomycin C group demonstrated significantly lower mean IOP at multiple postoperative intervals, including the first day, 6 months, and final visit (p < 0.001).
- At the final follow-up, 85.7% of mitomycin C-treated eyes achieved IOP <= 15 mm Hg, compared to 28.6% in the control group (p = 0.002).
- Life table analysis revealed a significantly higher probability of IOP control in the mitomycin C group (p = 0.0065), though choroidal effusion and shallow anterior chamber rates were higher in the treated group.
Conclusions:
- Low-dose intraoperative mitomycin C is effective in achieving and maintaining lower intraocular pressures after primary trabeculectomy in advanced POAG.
- While associated with a higher incidence of short-term complications like choroidal effusion and shallow anterior chamber, mitomycin C may serve as a valuable adjunct.
- This approach offers a potential alternative for managing advanced glaucomatous damage where achieving low target IOPs is paramount.