A placebo-controlled, double-masked evaluation of mitomycin C in combined glaucoma and cataract procedures.
OBJECTIVE
This study was performed to determine if adjunctive use of mitomycin C (MMC) would increase the success of combined phacoemulsification, intraocular lens implantation, and trabeculectomy surgery with releasable sutures.


METHODS
Seventy-two eyes with cataract and glaucoma, requiring surgery for decreased vision, uncontrolled intraocular pressure, or to obtain a better view of the optic nerve, were randomized to receive a 2.5-minute subconjunctival exposure to either MMC (0.5 mg/ml) or placebo balanced salt solution. Postoperative evaluations at 3, 6, and 12 months were performed by a masked observer who recorded visual acuity, intraocular pressure, glaucoma medications, presence of filtering blebs, and complications. Endothelial cell counts were measured before and 3 months after surgery.


RESULTS
The MMC group had significantly greater reduction in mean intraocular pressure through the first 12 months of follow-up (7.05-7.65 mmHg versus 2.62-3.84 mmHg; P = 0.001-0.028). In addition, through the first 6 months of follow-up, the MMC group required significantly fewer medications (0.4-0.5 versus 1.1-1.2; P = 0.002-0.004). Requirements for additional glaucoma surgery were less in the MMC group (4/ 36) than in the placebo group (7/35) (P = 0.301). Filtering blebs were significantly larger at 6 and 12 months (P = 0.002 and P = 0.001, respectively), and would leaks were more common (P = 0.101) in the MMC group. The mean decrease in endothelial cell count at month 3 was slightly, although not significantly, greater in the MMC treatment group (206.9 versus 91.3 cells/mm2* P = 0.377).


CONCLUSIONS
The increased success of the glaucoma procedure in the MMC group together with relatively minor toxicity, suggests its use is beneficial in combined glaucoma-cataract surgery.
Cohen
J S
JS
Glaucoma Service, Cincinnati Eye Institute, OH 45242, USA.
Greff
L J
LJ
Novack
G D
GD
Wind
B E
BE
D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D017024:Chemotherapy, Adjuvant; D004311:Double-Blind Method; D004728:Endothelium, Corneal / Q000166:cytology; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use*; D019384:Nucleic Acid Synthesis Inhibitors / Q000627:therapeutic use*; D018918:Phacoemulsification; D011183:Postoperative Complications; D014130:Trabeculectomy; D014792:Visual Acuity
D019384:Nucleic Acid Synthesis Inhibitors; D016685:Mitomycin