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Mallika Doss, Alice Z Chuang, Lauren Blieden; Subconjunctival injection vs surgical sponge application of mitomycin-C (MMC) during trabeculectomy in a county clinic. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2935.
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Evaluate short-term bleb failure and complication rates using subconjunctival injection or conventional sponge application of MMC.
Patients who underwent trabeculectomy with MMC between 2010 and 2014 at the Lyndon B. Johnson Hospital were included in this matched case-control study. A participant was assigned to the injection group if MMC was delivered by injection and was matched with a patient where MMC was delivered by sponge. Eyes were matched based on patient age (±5 years) and race. Eyes were excluded if there was concomitant surgery or prior scarring. If both eyes underwent injection, only one eye was included in the study. Bleb failure was defined as hypotony or restarting IOP-lowering medications. Because the injection method was first employed in 2013, only 6 month data was available and recorded.
Thirteen eyes in each study group were included. Baseline characteristics were similar, including mean treated IOP which was 24.6 mmHg (±9.2) and 24.3 mmHg (±9.8) for injection and sponge group, respectively. Ten (77%) eyes in the injection group versus 6 (46%) eyes in the sponge group underwent argon laser suture lysis. Two patients in each group required early bleb needling. Neither group had major intraoperative or postoperative complications nor underwent a second glaucoma surgery during the study timeframe. At 6 months, IOP reductions were similar [11.2 mmHg (±9.3) for injection and 11.9 mmHg (±12.0) for sponge]. Eight (62%) eyes in the injection group versus 5 (38%) of eyes in the sponge group were on IOP-lowering medications by 6 months after surgery (Table 1). The mean number of medications in the injection group was 1.5 while it was 2 in the sponge group.
In a county clinic setting, MMC delivery via subconjunctival injection has a similar complication rate to sponge delivery at 6 months, but a larger percentage of eyes in the study group were restarted on IOP-lowering medications. However, there may be a selection bias toward success in the sponge group because they may not have been selected if they had early failure. A larger study is required to further look into this surgical technique.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Table 1. Demographics, Ocular Baseline Characteristics, and Outcomes
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