[Trabeculectomy with mitomycin C supplemented with cross-linking hyaluronic acid: a pilot study].
BACKGROUND
Besides antimetabolites (5-fluorouracil [5-FU]), cytostatic agents (mitomycin C [MMC]) and topical steroids, various substances have been used for the modulation of wound healing in filtering glaucoma surgery. The anti-inflammatory effects of hyaluronic acid and its space-occupying properties may be useful in filtering as well as in non-filtering glaucoma surgery.


METHODS
In a non-randomised pilot study cross-linking hyaluronic acid (HealaFlow) was injected below the scleral flap and under the conjunctiva in 66 patients undergoing filtering surgery. All 66 patients (age 70.3 +/- 9.6 years; 41 - 88) had a standard trabeculectomy with MMC (0.25 % for 3 min). Glaucoma diagnoses were pseudoexfoliation glaucoma in 32 cases, primary open-angle glaucoma in 32 cases, ICE syndrome in one case and Axenfeld/Rieger in one case.


RESULTS
Intraocular pressure (IOP) levels were reduced from preoperatively 22.3 +/- 6.0 mmHg (12 - 40) with 2.7 +/- 1.0 (1 - 4) IOP-lowering medications to 11.9 +/- 5.1 mmHg (2 - 26) after 29.8 +/- 12.4 weeks (13 - 56) follow-up. Fifty-nine of the 66 patients (89.4 %) did not need IOP lowering medications at the end of the follow-up, 52 / 66 patients (78.8 %) had an IOP < or = 14 mmHg, 47 of these 52 patients (90.4 %) without medication. Argon laser suturolysis had to be performed in 28 / 66 eyes (42.4 %), 40 / 66 patients (60.6 %) required 1 - 4 subconjunctival injections of 15 mg (0.3 mL) 5-fluorouracil.


CONCLUSIONS
Injections of HealaFlow below the scleral flap and the conjunctiva at the end of the surgery along with intraoperative application of MMC showed promising IOP-lowering effects in trabeculectomy. A prospective randomised study is required to confirm these preliminary results.
Stürmer
J
J
Augenklinik Kantonsspital Winterthur, Winterthur, Schweiz. joerg.stuermer@ksw.ch
Mermoud
A
A
Sunaric Mégevand
G
G
D000276:Adjuvants, Immunologic / Q000008:administration & dosage; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003432:Cross-Linking Reagents / Q000008:administration & dosage / Q000737:chemistry; D004338:Drug Combinations; D004357:Drug Synergism; D015817:Eye Infections / Q000209:etiology* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D008297:Male; D016685:Mitomycin / Q000008:administration & dosage*; D010865:Pilot Projects; D014130:Trabeculectomy / Q000009:adverse effects* / Q000379:methods*; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects*
D000276:Adjuvants, Immunologic; D000903:Antibiotics, Antineoplastic; D003432:Cross-Linking Reagents; D004338:Drug Combinations; D016685:Mitomycin; D006820:Hyaluronic Acid