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Sze Ho Wong, Scott M Walsman, Albert S Khouri; Safety and Efficacy of Trabeculectomy with Mitomycin C Injection. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2938.
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© ARVO (1962-2015); The Authors (2016-present)
Trabeculectomy is traditionally performed with the placement of mitomycin-C (MMC) soaked sponges subconjunctivally to prevent fibrosis; however, the use of injected MMC has become popular. We evaluated the safety and efficacy of injecting MMC in trabeculectomy.
We performed a retrospective chart review on trabeculectomies with MMC injection performed by one surgeon (SMW). MMC 0.4 mg/mL was first diluted 50:50 with 2% lidocaine, then 0.2 mL of the mixture (equivalent to 40 μg MMC) was injected subconjunctivally in the beginning of surgery prior to subconjunctival space dissection and scleral flap creation. Inclusion criteria were age 18 to 100 years and uncontrolled intraocular pressure (IOP) despite maximum tolerated medical therapy. Exclusion criteria were no light perception vision, pregnant or nursing women, uveitis, superior conjunctival scarring, and previous trabeculectomy or tube shunt surgery in the same eye. Student T-tests between different time points and ethnicities were performed. Kaplan-Meier curve for absolute success was generated.
A total of 66 eyes were reviewed. Average follow-up time was 15.9±9.4 months. Significant IOP lowering was observed at all postoperative time points, as shown in Graph 1 (P<0.01). Number of glaucoma medications decreased from 3.6±0.5 preoperatively to 0.1±0.4 at last follow-up (P<0.01). Visual acuity remained unchanged at 0.4±0.4 logMAR (P=0.48). Postoperative failure was defined as IOP ≤5 mmHg or >21 mmHg in two consecutive visits, IOP not reduced by 20% from preoperative IOP in two consecutive visits, reoperation for glaucoma, or loss of light perception vision. Cumulative probability of failure during 2 years of follow-up was 12.5%. Postoperative complications are listed in Table 1. African American eyes (n=29) had undergone significantly more 5-fluorouracil injections (P<0.01), laser suture lysis procedures (P<0.01), and longer topical steroid duration (P<0.04) postoperatively, compared with Caucasian eyes (n=20).
Injecting 40 μg of MMC in trabeculectomy appeared effective, and the complication rate was comparable to MMC sponge historic data. Additional treatments were needed to prevent bleb failure in African American eyes. A prospective study with longer follow-up is needed to compare the outcomes of MMC injection versus MMC-soaked sponges in trabeculectomy.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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