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A randomized study of mitomycin augmentation in combined phacoemulsification and trabeculectomy
D W Carlson1, W L Alward, J P Barad
1Department of Ophthalmology, Wilford Hall Medical Center, Lackland AFB, USA.
Purpose:
The purpose of the study is to determine whether the intraoperative application of subconjunctival mitomycin C (MMC), during combined phacoemulsification and trabeculectomy, is an effective means of improving filtration, defined as overall lower intraocular pressure (IOP) and less antiglaucoma medication use.
Methods:
Twenty-nine patients with a visually significant cataract and glaucoma were randomized, in a double-masked fashion, to receive intraoperative MMC (0.5 mg/ml) or placebo.
Results:
Follow-up ranged from 6 to 30 months (mean, 20 months). Postoperative visual acuity at 1 year was 20/40 or better in 14 of 15 eyes operated on in the placebo group and 13 of 14 eyes operated on in the MMC group. Intraocular pressure at 8 months averaged 15.2 +/- 1.5 mmHg in the placebo-treated eyes versus 12.3 +/- 1.6 mmHg in the MMC-treated eyes. At 12 months, IOPs averaged 16.2 +/- 1.5 mmHg in the placebo-treated eyes versus 12.6 +/- 1.0 mmHg in the MMC-treated eyes. On average, the MMC group had postoperative IOP levels 3.0 mmHg lower than did the placebo group (P = 0.04) throughout the study. In the placebo group, laser suture lysis was required in a greater number of patients (80% versus 43%) and to a greater extent (mean = 2.0 versus 0.7 suture lysed) (P < 0.05). At 12 months, 5 of the 15 patients in the placebo group required an average of 1.8 medications for IOP control, whereas 0 of the 14 patients in the MMC group needed IOP-lowering medications. A late endophthalmitis developed through an intact bleb in one patient in the MMC group; otherwise, complications were minimal in each group.
Conclusion:
These results suggest that intraoperative MMC application, during combined phacoemulsification and trabeculectomy surgery, does improve early filtration as shown by overall lower IOPs and less antiglaucoma medication use.
Insights
Intraoperative mitomycin C (MMC) during combined cataract and glaucoma surgery significantly lowers intraocular pressure (IOP) and reduces the need for glaucoma medications, improving surgical outcomes.
Area of Science:
- Ophthalmology
- Glaucoma Surgery
- Cataract Surgery
Background:
- Combined phacoemulsification and trabeculectomy is a surgical approach for patients with both cataracts and glaucoma.
- Effective filtration is crucial for managing intraocular pressure (IOP) post-surgery.
- Mitomycin C (MMC) is an antifibrotic agent with potential to enhance filtration.
Purpose of the Study:
- To evaluate the efficacy of intraoperative subconjunctival mitomycin C (MMC) in improving filtration after combined phacoemulsification and trabeculectomy.
- To assess the impact of MMC on intraocular pressure (IOP) and the requirement for antiglaucoma medications.
Main Methods:
- A double-masked, randomized study involving 29 patients with cataracts and glaucoma.
- Patients received either intraoperative subconjunctival MMC (0.5 mg/ml) or a placebo during the combined surgery.
- Follow-up ranged from 6 to 30 months, with regular IOP and medication use assessments.
Main Results:
- The MMC group demonstrated significantly lower average IOP compared to the placebo group at 8 and 12 months post-surgery (P = 0.04).
- Fewer patients in the MMC group required laser suture lysis (43% vs. 80%) and less extensive lysis was needed.
- At 12 months, no patients in the MMC group required IOP-lowering medications, versus 5 in the placebo group.
Conclusions:
- Intraoperative subconjunctival MMC application during combined phacoemulsification and trabeculectomy improves early surgical filtration.
- MMC use leads to lower postoperative IOP and reduced reliance on antiglaucoma medications.
- Complications were minimal in both groups, with one case of late endophthalmitis in the MMC group.