A randomized study of mitomycin augmentation in combined phacoemulsification and trabeculectomy

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.