Success rate and complications of intraoperative 0.2 mg/ml mitomycin C in trabeculectomy surgery.
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 scleral flap) to both scleral 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 preoperative 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 scleral 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 scleral exposure to MMC. In addition a possible explanation for the serious side-effects of MMC-treated trabeculectomies is presented.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005901:Glaucoma / Q000601:surgery; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control; D014130:Trabeculectomy; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects*
D000903:Antibiotics, Antineoplastic; D016685:Mitomycin