Safety and efficacy of the use of intraoperative injection versus conventional sponge-applied mitomycin C during trabeculectomy

Abstract

 

Purpose

 

To study the safety and efficacy of intraoperative injection of Mitomycin (MMC) against conventional sponge-applied MMC during trabeculectomy (Trab).

 

Methods

 

Consecutive patients that underwent intraoperative MMC injection during Trab were identified and retrospectively reviewed. Patients who underwent conventional sponge-applied MMC served as control. Procedures were performed by a single surgeon by injecting 0.1ml of 50:50 diluted 0.4mg/ml MMC with lidocaine. Data on visual acuity (VA), intraocular pressure (IOP), number of glaucoma medications, post-op complications, interventions, and any additional surgery were collected at baseline and post-op: day 1, week 1, month 1, 3, and 6. Means, SD, T-test, chi-square, or Fisher’s exact tests were performed.

 

Results

 

In total, 50 eyes were included: 25 intraoperative MMC injection, and 25 sponge-applied MMC. There were no differences in baseline IOP, VA, or number of glaucoma medications between groups. Although the injection group had overall lower mean IOP and higher proportions of >30% IOP reduction from baseline than the sponge group, this did not reach significance. There were no significant differences at any time point in post-op IOP, VA, number of glaucoma medications, or complications when comparing outcomes between groups (Table 1). Proportion of eyes achieving IOP reduction >30% from baseline without or with medications were similar between groups (Table 2). There was no significant difference between groups in post-op complications including bleb leak, hypotony, shallow AC, infection, corneal edema/haze, cataract formation (p=0.19) (Table 3). The proportion of eyes needing 5-FU and LSL post-op interventions in the injection group was significantly lower than sponge group (Table 3). No patients in the injection group needed additional surgery or revisions whereas two patients in the sponge group needed revision and/or a second glaucoma surgery.

 

Conclusions

 

Injection of MMC during trab was safe and as effective as conventional sponge application of MMC with less need for post-op interventions or revisions. Longer follow-up of a larger cohort is needed to further characterize the efficacy and safety of this modality.

 

 

Table 1. IOP and number of medications

 

 

Tables 2 and 3

 

Keywords: 568 intraocular pressure • 765 wound healing • 561 injection