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Alastair Lockwood, Sumit Dhingra, Hala Fadda, Anja Vetter, Ashkan Khalili, Steve Brocchini, Peng T. Khaw; A Single Application Sustained Release Matrix Metalloproteinase Inhibitor At A Low Dose Is Superior To Mitomycin C In Prolonging Bleb Survival. Invest. Ophthalmol. Vis. Sci. 2011;52(14):616.
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The application of a matrix metalloproteinase inhibitor (MMPi) is a potential non-toxic alternative to mitomycin C (MMC) for prolonging bleb survival in glaucoma surgery. Previous studies in our group have shown promise using a higher dose (2.3 mg) of a sustained release excipientless tablet of ilomastat, an MMPi (IOVS 2008;49: E-Abstract 4538). In this in vivo study, we determined whether a low dose tablet was able to achieve a similar therapeutic effect.
A randomised, prospective, masked, single observer in vivo study over 30 days was conducted. Glaucoma filtration surgery was performed on 28 New Zealand White rabbits. The rabbits received perioperatively one of four potential subconjunctival treatments, randomised according to a Latin Square
The ilomastat 1 mm (0.5 mg) treated rabbits had blebs that all survived to day 30. The ilomastat 2 mm (1 mg) group all survived until day 27 and 86 % (6) to day 30. Of the MMC treated group 29 % (2) had successful blebs at day 30, and of the ethylcellulose treated group 43 % (3) had successful blebs at day 30. The differences in bleb survival between the ilomastat 1mm and ethylcellulose tablets, and the ilomastat 1 mm and MMC groups were statistically significant (log rank P = 0.0221 and 0.0078 respectively).
A low dose (0.5 mg) of ilomastat appears to be as successful in bleb survival as the higher doses that have been examined. This will allow the method of drug delivery to be refined and allow easier application in the post-operative period.
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