ABSTRACT
Objective:
The aim of this study was to evaluate the efficacy and safety of trabeculectomy performed with mitomycin C (MMC) at a concentration of 0.2 mg/mL for 3 minutes in glaucoma patients with high risk of surgical failure.
Methods:
Forty-seven eyes of 45 patients (30 male, 15 female) undergoing glaucoma filtration surgery using MMC were retrospectively reviewed. All patients who had chronic closed angle, neovascular, aphakic, pseudophakic, pseudoexfoliation glaucoma and glaucoma after keratoplasty had a high risk of surgical failure. During standard trabeculectomy, triangular sponges impregnated with MMC at a concentration of 0.2 mg/mL were applied to tenon and episcleral space in sub-conjunctival regions and under the scleral flap for 3 minutes. Postoperative IOP, appearance of filtration bleb, anterior chamber depth, leakage detected with Seidel test and other complications were recorded. The patients were evaluated on the 1st day, 1st week, 1st month, 3rd month, 6th month and 12th month.
Results:
The mean preoperative IOP values of patients with a mean age of 64.5 (7-83 years) were 31.6 mmHg (17-60 mmHg). Mean postoperative IOP values of patients were 15.08 mmHg at 1st week, 15.32 mmHg at 1st month, 15.57 mmHg at 3rd month, 16.42 mmHg at 6 months, 16.28 mmHg at 12 months, and 16.87 mmHg at the last follow-up.
Conclusion:
For eyes with high risk of surgical failure, trabeculectomy performed with MMC at low dose and optimal time is an effective and reliable method with high success rate.
Keywords:
Mitomycin C, glaucoma, high risk of surgical failure
References
1Skuta GL, Parrish RK II. Wound healing in glaucoma filtrating surgery. Surv Ophthalmol 1987;32:149-70.
2Costa VP, Speath GL, Eiferman RA, Orengo-Nania S. Wound healing modulation in glaucoma filtration surgery. Ophthalmic Surg 1993;24:152-70.
3Singh P, Singh A. Mitomycin-C use in ophthalmology. J Pharm 2013;3:12-4.
4Bergstrom T,Wilkinson W, Skuta G. The effects of subkonjunctival mitomycin-C on glaucoma filtration surgery in rabbits. Arch Ophthalmol 1991;109:1725-30.
5Shields MB, Scroggs MW, Sloop CM, Simmons RB. Clinical and histopathological observations concerning hypotony after trabeculectomy with adjunctive mitomycin C. Am J Ophthalmol 1993;116:673-8.
6Hollo G. Wound healing and glaucoma surgery: modulating the scarring process with conventional antimetabolites and new molecules. Dev Ophthalmol 2012;50:79-89.
7El Sayyad F, Belmekki M, Helal M, Khalil M, El-Hamzawey H, Hisham M. Simultaneous subkonjunctival and subscleral mitomycin C application in trabeculectomy. Ophthalmology 2000;107:298-301.
8Hitchings RA, Grierson I. Clinicopathological correlation in eyes with failed fistulizing surgery. Trans Ophthalmol Soc U K 1983;103:84-8.
9You YA, Gu YS, Fang CT, Ma XQ. Long term effects of simultaneous subconjunctival and subscleral mitomycin C application in repeat trabeculectomy. J Glaucoma 2002;11:110-8.
10Romero P, Hirunpatravong P, Alizadeh R, Kim EA, Nouri-Mahdavi K, Morales E, et al. Trabeculectomy with Mitomycin-C: Outcomes and Risk Factors for Failure in Primary Angle-Closure Glaucoma. J Glaucoma 2018;27:101-7.
11Akarsu C. Yüksek riskli glokom cerrahisinde düşük doz 5-FU ile MMC uygulamalarının uzun dönem sonuçları. T Klin Oftalmoloji 2003,12:192-9.
12S Khouri A, Huang G, Y Huang L. Intraoperative Injection vs Sponge-applied Mitomycin C during Trabeculectomy: One-year Study. J Curr Glaucoma Pract 2017;11:101-6.
13Robin AL, Ramakrishnan R, Krishnadas R, Smith SD, Katz JD, Selvaraj S, et al. A long-term dose-response study of mitomycin in glaucoma filtration surgery. Arch Ophthalmol 1997;115:969-74.
14Neelakantan A, Rao BS, Vijaya L, Grandham SB, Krishnan N, Priya VS, et al. Effects of concentration and duration of application of mitomycin C in trabeculectomy. Ophthalmic Surg 1994;25:612-5.
15Rasheed el-S. Initial trabeculaectomy with intraoperative mitomycin C application in primary glaucomas. Ophthalmic Surg Lasers 1999;30:360-6.
16Chen CW. Enhanced intraocular pressure controlling effectiveness of trabeculectomy by by local application of mitomycin-C. Trans Asia Pac Acad Ophthalmol 1983;9:172-7.
17Shieds MB. Clinical and histopathologic observation concerning hypotony after trabeculectomy and adjunctive mitomycin C. Am J Ophthalmol 1993;116:673-83.
18Zacharia PT, Depperman SR. Ocular hypotony after trabeculectomy with mitomycin C. Am J Ophthalmol 1993;116:314-26.
19Özkurt Y. Penetran keratoplasti sonrası glokomda mitomisin C’li ve mitomisin C’siz trabekülektomi. T Oft Gaz 2003;33:255-9.