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Published on: July 1, 2013
Molteno implant with mitomycin C: intermediate-term results
T W Perkins1, R Gangnon, W Ladd
1Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison 53705-3631, USA.
Purpose:
The authors examine the intermediate-term effects of adjunctive intraoperative mitomycin C (MMC) in a cohort of patients who received double-plate Molteno implants for complicated glaucomas.
Methods:
A consecutive series of 21 patients who received MMC 0.5 mg/ml for 5 minutes as an adjunct to a double-plate Molteno implant was compared by life-table analysis to a historical control group of 18 patients who received either no adjunct or 5-fluorouracil (5-FU) but no MMC.
Results:
At three years follow-up, 35% (95% confidence interval (CI), 15-57%) of patients who received MMC avoided failure criteria of intraocular pressure (IOP) less than 6 mm Hg or more than 21 mm Hg, addition of glaucoma medication, reoperation for glaucoma, or tube removal. Seventeen percent (95% CI, 4-37%) of patients in the control group at three years follow-up met similar criteria (p = 0.039). No late complications of tube erosion were seen in the MMC group.
Conclusion:
Intraoperative MMC offers an increased likelihood of a two- to three-year period of medication-free IOP control in patients undergoing double-plate Molteno implants, compared to similar patients receiving 5-FU or no adjunctive antimetabolite therapy.
Insights
Adjunctive intraoperative mitomycin C (MMC) improved medication-free intraocular pressure control for up to three years in patients with complicated glaucomas receiving Molteno implants. This glaucoma surgery adjunct showed better outcomes than 5-fluorouracil or no adjunctive therapy.
Area of Science:
- Ophthalmology
- Glaucoma Surgery
- Pharmacology
Background:
- Complicated glaucomas often require surgical intervention with implants like the Molteno double-plate device.
- Adjunctive antimetabolite therapy is sometimes used to enhance surgical outcomes.
- Mitomycin C (MMC) is an antimetabolite with potential applications in glaucoma surgery.
Purpose of the Study:
- To evaluate the intermediate-term efficacy and safety of adjunctive intraoperative mitomycin C (MMC) in patients undergoing double-plate Molteno implantation for complicated glaucomas.
- To compare outcomes in patients receiving MMC with a historical control group.
Main Methods:
- A consecutive series of 21 patients received MMC (0.5 mg/ml for 5 minutes) adjunctively with Molteno implants.
- Life-table analysis was used to compare this group with 18 historical controls who received no adjunct or 5-fluorouracil (5-FU).
- Failure criteria included intraocular pressure (IOP) outside the 6-21 mm Hg range, added glaucoma medication, reoperation, or tube removal.
Main Results:
- At three years, 35% of the MMC group avoided failure criteria, compared to 17% in the control group (p = 0.039).
- The MMC group demonstrated a significantly higher likelihood of achieving medication-free IOP control.
- No late complications such as tube erosion were observed in the MMC group.
Conclusions:
- Intraoperative MMC significantly increases the probability of achieving medication-free intraocular pressure control for two to three years post-Molteno implantation.
- MMC appears to be a safe and effective adjunct for complicated glaucoma surgery.
- The findings support the use of MMC as an adjunctive therapy in specific glaucoma surgical cases.
