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Mitomycin-C in congenital glaucoma

H C Agarwal¹, N N Sood, R Sihota

¹Glaucoma Service, Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

Ophthalmic Surgery and Lasers

|January 15, 1998

Summary

Mitomycin-C (MMC) at 0.2 mg/ml effectively controlled intraocular pressure in congenital glaucoma surgery, similar to 0.4 mg/ml. The lower concentration resulted in fewer complications and thinner blebs.

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Area of Science:

Ophthalmology
Glaucoma Surgery
Ocular Pharmacology

Background:

Congenital glaucoma presents significant challenges in intraocular pressure (IOP) management.
Trabeculotomy and trabeculectomy are common surgical interventions for congenital glaucoma.
The adjunctive use of mitomycin-C (MMC) aims to enhance surgical outcomes.

Purpose of the Study:

To evaluate the efficacy and safety of different concentrations of mitomycin-C (MMC) as an adjunct in trabeculotomy and trabeculectomy for high-risk congenital glaucoma.
To compare the impact of 0.2 mg/ml versus 0.4 mg/ml MMC on postoperative IOP control and surgical success rates.

Main Methods:

A prospective, randomized, double-blind study involving 16 high-risk congenital glaucoma cases (30 eyes).
Patients were randomized to receive either 0.2 mg/ml (group 1) or 0.4 mg/ml (group 2) of MMC during surgery.
Intraocular pressures (IOPs) and surgical outcomes were monitored postoperatively.

Main Results:

Both MMC concentrations achieved similar IOP control with medication (86.7% in each group).
Without medication, 60% of eyes in group 1 and 86.67% in group 2 achieved IOP control (< 21 mm Hg).
Avascular, thin blebs were more frequent in group 2 (66.67%) compared to group 1 (33.3%). Complications like hyphema and hypotony occurred in both groups, with serous choroidal detachment and wound leakage noted in group 2.

Conclusions:

Intraoperative mitomycin-C (MMC) at 0.2 mg/ml is as effective as 0.4 mg/ml for IOP control in high-risk congenital glaucoma.
The lower concentration (0.2 mg/ml) is associated with a reduced incidence of complications and thinner-walled blebs.

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