Molteno implant with mitomycin C: intermediate-term results

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.