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A fluorophotometric study of corneal endothelium after trabeculectomy using different concentrations of Mitomycin-C
A Szymanski1, A Gierek-Lapinska, M Koziak
1Silesian School of Medicine, Department of Ophthalmology, Poland.
Abstract:
The aim of the study was to determine the corneal endothelial permeability coefficient (Pac) in subjects after trabeculectomies using different concentrations of Mitomycin-C (MMC). MMC, a highly toxic drug, is not without drawbacks and complications such as corneal damage. To ascertain a possible relationship between a level of endothelial permeability (Pac) and concentrations of MMC used, we performed, in a prospective study, trabeculectomies in cases of primary open-angle glaucoma (POAG), younger than 50 years, with either concentrations of 0.5 mg/ml of MMC (group 1: 11 eyes) or 0.2 mg/ml of MMC (group 2: 10 eyes). Group 3 consisted of 8 patients after a typical trabeculectomy without MMC and served as a control group (8 eyes). In all groups, before surgery and again 1, 3 and 6 months after surgery, corneal endothelial permeability (Pac) was determined by using anterior segment fluorophotometry (Fluorotron Master). The thickness of the cornea (CT) was measured with a DGH Technology ultrasonic pachymeter. One month after surgery the mean values of Pac were statistically significantly higher in groups 1 and 2 (group 1: 4.78 x 10(-4) cm/min, group 2: 4.67 x 10(-4) cm/min) in comparison with the control group (group 3: 3.37 x 10(-4) cm/min), but the differences between groups 1 and 2 were not statistically significant (p = 0.05). Six months after operation the mean values of Pac in all groups were normalized. In eyes that underwent trabeculectomy with MMC, higher concentrations of MMC were likely to have a transient adverse effect on corneal endothelial permeability. In light of the resulting toxic intraocular effect of MMC, the damage in the function of the corneal endothelial barrier is greater with greater concentrations of MMC.
Insights
Higher concentrations of Mitomycin-C (MMC) temporarily increase corneal endothelial permeability after glaucoma surgery. This effect normalizes by six months, but higher MMC doses cause greater transient damage to the corneal endothelial barrier.
Area of Science:
- Ophthalmology
- Glaucoma Surgery
- Corneal Physiology
Background:
- Trabeculectomy is a surgical procedure to treat glaucoma.
- Mitomycin-C (MMC) is used during trabeculectomy to enhance surgical outcomes.
- MMC is a cytotoxic agent with potential adverse effects on the cornea.
Purpose of the Study:
- To investigate the effect of different Mitomycin-C (MMC) concentrations on corneal endothelial permeability (Pac) after trabeculectomy.
- To determine if a correlation exists between MMC concentration and the degree of corneal endothelial permeability.
- To assess the transient or permanent nature of MMC's impact on the corneal endothelial barrier.
Main Methods:
- Prospective study involving primary open-angle glaucoma (POAG) patients under 50 years old.
- Three groups: trabeculectomy with 0.5 mg/ml MMC (n=11), 0.2 mg/ml MMC (n=10), and no MMC (control, n=8).
- Corneal endothelial permeability (Pac) measured by anterior segment fluorophotometry at baseline, and 1, 3, and 6 months post-surgery. Corneal thickness (CT) also measured.
Main Results:
- One month post-surgery, mean Pac was significantly higher in both MMC groups (0.5 mg/ml and 0.2 mg/ml) compared to the control group.
- No significant difference in Pac was observed between the two MMC concentration groups at one month (p = 0.05).
- By six months post-surgery, mean Pac values returned to normal in all groups, indicating a transient effect.
Conclusions:
- Higher concentrations of Mitomycin-C (MMC) are associated with a transient adverse effect on corneal endothelial permeability following trabeculectomy.
- The degree of corneal endothelial barrier damage appears to be dose-dependent, with higher MMC concentrations causing greater transient impairment.
- The corneal endothelial permeability returns to baseline levels within six months after surgery, suggesting the toxic effects of MMC are temporary.