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Jiun Do, Benjamin Xu, Andrew Camp, Philip Ngai, Robert N Weinreb; Subconjuctival Injection Versus Direct Scleral Application of Mitomycin-C in Trabeculectomy. Invest. Ophthalmol. Vis. Sci. 2018;59(9):471. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
A prospective study was performed to compare the efficacy and safety of trabeculectomy with preoperative subconjunctival injection or direct intraoperative application of Mitomycin-C (MMC).
A prospective, randomized study was initiated at the University of California San Diego Shiley Eye Institute including eyes with medically uncontrolled open angle glaucoma scheduled to undergo trabeculectomy. Eyes were randomized to receive MMC either by preoperative, subconjunctival injection (0.15mL of 0.2mg/mL) (injection group) or intraoperative, direct scleral application (0.4mg/mL soaked cellulose sponges for 1-2 minutes) (sponge group). Primary outcome measures were postoperative IOP at day 1, week 1, week 6, and month 3. Complete success was defined as an IOP <21 mm Hg or at least a 30% reduction in IOP without glaucoma medications. Secondary outcome measures were bleb morphology assessed by the Indiana Bleb Appearance Grading Scale, complications, and postoperative manipulations (e.g., needling and subconjunctival 5-fluorouracil injections).
43 consecutive eyes undergoing trabeculectomy were randomly assigned to the injection (n=24) or sponge (n=19) group. Demographic and preoperative characteristics between groups were similar except for age (injection: 74.4 ± 9.1 years, sponge: 67.2 ± 12.8 years, p=0.019) and number of glaucoma medications (injection: 2.4 ± 1.1, sponge: 3.1 ± 1.0, p=0.011). At postoperative month 3, there were no differences between groups by mean IOP, percent IOP reduction, proportion of eyes with at least 30% IOP reduction, or proportion of complete successes. There were no differences between groups by complication rates, postoperative interventions, or bleb morphology by height, extension, vascularity, or leakage.
Short-term success rates are similar between subconjunctival injection and direct scleral application of MMC in trabeculectomy. The method of MMC application does not significantly affect bleb morphology, complications, or postoperative interventions. Additional follow up is indicated for long-term outcomes.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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