Abstract
Adjunctive chemotherapy with Mitomycin C (MMC) has been used in an attempt to modulate the wound healing response in glaucoma filtration surgery. A consecutive series of 20 eyes from 18 patients undergoing trabeculectomy with MMC intraoperatively was studied. Sixteen cases were considered high risk regarding surgical success and 4 patients with low tension glaucoma (LTG) required lower intraocular pressure (IOP) to prevent further visual field loss. Surgical technique involved the use of a limbal-based conjunctival flap and MMC 0.2 mg/ml applied via a sponge (under the scierai flap) to both scierai and conjunctival surfaces for 5 minutes. The mean follow-up period was 12.7 months (range 3-24). There were 17 successful eyes. Of these, 14 are high pressure glaucoma eyes with a mean pre-operative IOP of 30.9 ± 10.9 mmHg and a mean postoperative IOP of 15.3 ± 5.2 mmHg (p = 0.001). The remainder of the successful cases include 4 patients with LTG with a mean pre-operative IOP of 17.8 ± 0.5 mmHg and a mean postoperative IOP of 6.8 ± 0.7 mmHg (p = 0.001). Serious complications included chronic repeated bleb leaks (n = 2) and scierai necrosis (n = 2). There was one case of hypotonous maculopathy. These results are comparable with those of other studies. Despite a relatively low dose of MMC serious side-effects were encountered. Management of these complications is described, and how these effects may be prevented by altering scierai exposure to MMC. In addition a possible explanation for the serious side-effects of MMC-treated trabeculec-tomies is presented.
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Singh, J., O'Brien, C. & Chawla, H. Success rate and complications of intraoperative 0.2 mg/ml Mitomycin C in trabeculectomy surgery. Eye 9, 460–466 (1995). https://doi.org/10.1038/eye.1995.107
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DOI: https://doi.org/10.1038/eye.1995.107
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