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Miaomiao Zhang, Bin Li, Wei Liu, Jianrong Wang, Xinyi Wu; Subconjunctival Versus Intrascleral Application of Mitomycin C During Trabeculectomy. Invest. Ophthalmol. Vis. Sci. 2014;55(7):4639-4644. doi: 10.1167/iovs.14-14159.
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To compare the efficacy and safety between subconjunctival and intrascleral methods of mitomycin C (MMC) application during trabeculectomy.
This retrospective study included 165 eyes treated by trabeculectomy and compared clinical outcomes between eyes that received subconjunctival MMC (Group 1, 80 eyes, 48.5%) and eyes that received intrascleral (Group 2, 85 eyes, 51.5%) MMC. Surgical success was defined as an IOP of 6 to 21 mm Hg with or without topical antiglaucoma medication use.
Mean IOP values were not significantly different between Groups 1 and 2 (P > 0.05) until 2 weeks after surgery, while they differed significantly at 1, 3, 6, 12, and 24 months after surgery (P < 0.05). The mean number of antiglaucoma medications was 3.6 ± 0.6 and 3.5 ± 0.7, respectively, before surgery (P = 0.327), and 0.27 ± 0.32 and 0.10 ± 0.29, respectively, at 24 months after surgery (P = 0.001). The surgical success rate at 24 months was 86.25% and 94.12% in Groups 1 and 2, respectively (P = 0.041, log-rank test). Encysted blebs were observed in 17 and 8 patients in Groups 1 and 2 (P = 0.034), respectively, at 24 months. There was no statistically significant difference in the incidence of hypotony, choroidal detachment, conjunctival leakage, cataract, and the rate of postoperative procedures between Groups 1 and 2 (P > 0.05).
Compared to subconjunctival MMC application, intrascleral MMC application can increase the long-term success of trabeculectomy without increasing the complication rates.
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