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Sarah Syeda, Raghad Kherallah, Chaesik Kim, Bret Hughes; Injected vs. topical mitomycin C in patients undergoing trabeculectomy; long-term outcomes. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6631.
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The use of mitomycin C (MMC) in trabeculectomies has long been used to prevent scarring and reduce the risk of failure. However, the mode of delivery has not been extensively researched. The purpose of this study was to compare long-term outcomes in those who had intraoperative injection of MMC (INJ) or sponge-soaked topical MMC (TOP) during trabeculectomy.
Patients who underwent trabeculectomy and had at least 2 year follow-up were included in this retrospective study. Data for intraocular pressure (IOP), best-corrected visual acuity (BCVA), number of glaucoma medications, and postoperative complications were collected preoperatively and postoperatively at different time intervals.
206 patients who underwent trabeculectomy at the Kresge Eye Institute between 2011-2018 were included. Of these, 28 eyes fell into the INJ group and received 0.4 mg/ml injected MMC, and 178 eyes were included in the TOP group. 53.6% of the INJ group and 47.8% of the TOP were male. At presentation, mean age (± standard deviation) was 66.2 years ± 10.6 in the INJ group and 69.0 years ± 13.1 in the TOP group. Baseline IOP was 23.8 mmHg ± 7.0 vs. 25.9 mmHg ± 10.8, and number of medications was 3.68 ± 0.9 vs 3.13 ± 1.1 in INJ vs TOP group respectively. At 2 year follow-up, IOP reduced to 15.8 mmHg ± 4.1 vs 14.4 mmHg ± 5.1, and number of medications was 2.0 ± 1.3 vs 1.31 ± 1.4 in INJ vs TOP group. IOP significantly reduced from baseline in both INJ (33.4% p=0.04) and TOP (44.1% p<0.001), but there was no significant difference between the groups at 2 years (p=0.31). Number of medications also reduced significantly in the INJ group (62% p<0.001) and TOP group (72% p<0.001). However, TOP had a greater medication reduction that was significantly different from INJ (p<0.05) at 2 year follow up. By 2 year follow up, 21.5% of the INJ group needed bleb needling vs 11.8% of the TOP group, and 17.9% of INJ had post-op complications vs. 15.8% of TOP.
IOP and the number of medications after a trabeculectomy both reduced whether MMC was injected or used topically intraoperatively. This study highlights that topical MMC may be more beneficial in achieving the same IOP reduction as injected, but with less medication burden, bleb needling and complications. This reveals a potential factor to consider intra-operatively in glaucoma patients undergoing trabeculectomy.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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