Aim: The aim of this study is to compare the outcomes, success rates, complications, and number of interventions of the trabeculectomy surgery with mitomycin C (MMC) in two different techniques: conventional soaked sponges and sub-Tenon injection.
Materials and methods: An observational retrospective study was performed with 79 eyes of 64 participants who underwent a glaucoma surgery with MMC. The conventional sponge soaked with MMC 0.03% for 3 minutes over the scleral flap (group I) and the subtenon injection of 0.1 mL of MMC 0.03% (group II) techniques were used to deliver the MMC. The data collected were patient demographics, preoperative intraocular pressure (IOP), central corneal thickness (CCT), number of pre- and postoperative ocular hypotensive drugs, postoperative complications, number of interventions, and need of further glaucoma surgery.
Results: Seventy-nine eyes were divided into two: 39 eyes (49.37%) in group I and 40 eyes (50.63%) in group II. Trabeculectomy was performed in 53.17% and phacotrabeculectomy in 46.83%. The IOP decreased from 18.0 ± 11.0 mm Hg at the baseline to 10.0 ± 3.0 mm Hg at the last visit in group I and, in group II, from 16.0 ± 10.0–13.0 ± 6.0 mm Hg (median ± ID), p < 0.001. There were no significant differences between the groups regarding demographics, median follow-up, IOP in baseline, CCT, drugs reduction, success criteria adopted, postsurgical interventions, surgical complications, and need for new procedures (p > 0.05).
Conclusion: Sub-Tenon injection of MMC is a safe and as effective as the conventional soaked sponge method in trabeculectomies. This method reduces surgical time and sponge-related risks with equivalent surgical efficacy.
Clinical significance: As trabeculectomy is still the most common surgical procedure to reduce IOP and scar formation is one of the main causes of surgical failure, it is important to develop surgical techniques to improve its outcomes.
Coleman AL. Advances in glaucoma treatment and management: surgery. Invest Ophthalmol Vis Sci 2012;53(5):2491–2494. DOI: 10.1167/iovs.12-9483l.
Gedde SJ, Herndon LW, et al. Surgical complications in the Tube vs Trabeculectomy Study during the first year of follow-up. Am J Ophthalmol 2007;143(1):23–31. DOI: 10.1016/j.ajo.2006. 07.022.
Edmunds B, Thompson JR, et al. The National Survey of Trabeculectomy. II. Variations in operative technique and outcome. Eye (Lond) 2001;15:441–448. DOI: 10.1038/eye.2001.152.
Skuta GL, Parrish II RK. Wound healing in glaucoma filtering surgery. Surv Ophthalmol 1987;32(3):149–170. DOI: 10.1016/0039-6257(87)90091-9.
Joshi AB, Parrish RK, et al. 2002 survey of the American Glaucoma Society: practice preferences for glaucoma surgery and antifibrotic use. J Glaucoma 2005;14(2):172–174. DOI: 10.1097/01.ijg.0000151684.12033.4d.
Wilkins M, Indar A, et al. Intra-operative mitomycin C for glaucoma surgery. Cochrane Database Syst Rev 2001(1):CD002897. DOI: 10.1002/14651858.CD002897.
You YA, Gu YS, et al. Long-term effects of simultaneous subconjunctival and subscleral Mitomycin-C application in repeat trabeculectomy. J Glaucoma 2002;11(2):110–118. DOI: 10.1097/00061198-200204000-00006.
Falck FY Jr, Skuta GL, et al. Mitomycin vs 5-fluoruracil anti-metabolite therapy for glaucoma filtration surgery. Semin Ophthalmol 1992;7: 97–109. DOI: 10.3109/08820539209065098.
Sisto D, Vetrugno M, et al. The role of antimetabolites in filtration surgery for neovascular glaucoma: intermediate-term follow-up. Acta Ophthalmol Scand 2007;85(3):267–271. DOI: 10.1111/j.1600-0420.2006.00810.x.
Beatty S, Potamitis T, et al. Trabeculectomy augmented with Mitomycin-C application under thescleral flaps. Br J Ophthalmol 1998;82(4):397–403. DOI: 10.1136/bjo.82.4.397.
Palmer SS. Mitomycin as adjunct chemotherapy with trabeculectomy. Ophthalmology 1991;98(3):317–321. DOI: 10.1016/S0161-6420(91)32293-0.
Shin DH, Tsai CS, et al. Retained cellulose sponge after trabeculectomy with adjunctive subconjunctival mitomycin-C. Am J Ophthalmol 1994;118(1):111–112. DOI: 10.1016/S0002-9394(14) 72853-3.
Lee E, Doyle E, et al. Trabeculectomy surgery augmented with intra-Tenon injection of mitomycin C. Acta Ophthalmol 2008;86(8): 866–870. DOI: 10.1111/j.1755-3768.2007.01147.x.
Sawchyn AK, Slabaugh MA. Innovations and adaptations in trabeculectomy. Curr Opin Ophthalmol 2016;27(2):158–163. DOI: 10.1097/ICU.0000000000000236.
Khaw PT, Chiang M, et al. Enhanced trabeculectomy: the Moorfields Safer Surgery System. Dev Ophthalmol 2012;50:1–28. DOI: 10.1159/000334776.
Khaw PT. Advances in glaucoma surgery: evolution of antimetabolite adjunctive therapy. J Glaucoma 2001;10(5):S81–S84. DOI: 10.1097/00061198-200110001-00029.
Lim MC, Tong MG, et al. A comparison of trabeculectomy surgery outcomes with mitomycin-C applied by intra-tenon injection vs sponge method. American Glaucoma Society 23rd Annual Meeting 2013.
Pakravan M, Esfandiari H, et al. Mitomycin C-augmented trabe- culectomy: subtenon injection vs soaked sponges: a randomised clinical trial. Br J Ophthalmol 2017;101(9):1275–1280. DOI: 10.1136/bjophthalmol-2016-309671.