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Ocular concentrations of mitomycin C using different delivery devices
H Mietz1, M Diestelhorst, A F Rump
1Department of Opthalmology, University of Cologne, Köln, Germany.
Abstract:
Hypotony and its sequelae are a frequent complication of trabeculectomies performed with mitomycin C (MMC), possibly related to intraocular toxicity of the substance. In an animal model with rabbits, we used different devices for the application of MMC and measured extra- and intraocular concentrations by HPLC. In addition, the concentrations of MMC remaining in the devices were determined. The devices were (1) a regular surgical sponge, (2) a scleral shield, (3) a presoaked soft contact lens, (4) a soft contact lens with MMC application, and (5) subconjunctival injection. Ocular concentrations of MMC were similar within the first 4 groups and were highest in the last. The measurements suggest that MMC penetrates intraocularly regardless of the device used. The variability of remaining MMC concentrations in the devices was lowest in the soft contact lenses suggesting an improved delivery system compared to the usually used surgical sponges.
Insights
Mitomycin C (MMC) application during glaucoma surgery can cause hypotony. This study found MMC penetrates the eye regardless of application method, but soft contact lenses offer more consistent delivery compared to sponges.
Area of Science:
- Ophthalmology
- Pharmacology
- Surgical Research
Background:
- Hypotony is a common complication after trabeculectomy with mitomycin C (MMC).
- Intraocular toxicity of MMC may contribute to hypotony and its sequelae.
- Optimizing MMC delivery is crucial for reducing ocular complications.
Purpose of the Study:
- To evaluate different application devices for mitomycin C (MMC) in an animal model.
- To measure extra- and intraocular MMC concentrations and remaining device concentrations.
- To compare the delivery consistency of various MMC application methods.
Main Methods:
- Rabbits were used as an animal model.
- Mitomycin C (MMC) was applied using five different devices: surgical sponge, scleral shield, presoaked soft contact lens, soft contact lens with MMC application, and subconjunctival injection.
- High-performance liquid chromatography (HPLC) was used to measure MMC concentrations.
- Remaining MMC concentrations in the devices were quantified.
Main Results:
- Intraocular MMC concentrations were comparable across the first four application groups (sponge, shield, contact lenses).
- Subconjunctival injection resulted in the highest ocular MMC concentrations.
- MMC demonstrated intraocular penetration irrespective of the delivery device.
- Soft contact lenses exhibited the lowest variability in remaining MMC concentrations, indicating improved delivery consistency.
Conclusions:
- Mitomycin C (MMC) penetrates the eye regardless of the application device used in trabeculectomy.
- Soft contact lenses represent a potentially improved delivery system for MMC compared to traditional surgical sponges due to lower variability.
- Further research into optimized MMC delivery methods is warranted to mitigate hypotony and enhance surgical outcomes.