Intraoperative mitomycin C versus intraoperative 5-fluorouracil for trabeculectomy: a systematic review and meta-analysis.
OBJECTIVE
The aim of this study was to assess the intraoperative application of mitomycin C (MMC) compared to 5-fluorouracil (5-FU) on the outcome of trabeculectomy and to examine the balance of risk and benefit.


METHODS
Pertinent studies were selected through systematic searches of major literature databases, including the Cochrane Library, PubMed, Embase, and Chinese Biomedicine Database. Internet searches of search engines, the professional associations' websites, and the manufacturers' databases were also performed. Clinical controlled trials comparing 5-FU with MMC in trabeculectomy were selected. The primary efficacy measure was the weighted mean difference (WMD) in percentage intraocular pressure reduction (IOPR%) at follow-up end point. The secondary efficacy measure was the relative risk (RR) for "qualified" (with or without medical therapy) success of trabeculectomy at follow-up end point. The third efficacy measure was RR for "complete" (without medical therapy) success of trabeculectomy at follow-up end point. The fourth efficacy measure was RR for adverse events, including wound leak, hypotony, endophalmitis, and shallow anterior chamber (AC). The pooled effects were calculated using the random effects model by RevMan version 5.0 software.


RESULTS
Eight studies enrolling a total of 536 patients were included in the meta-analysis. MMC was associated with significantly more IOPR% compared with 5-FU, with a WMD of 7.09 [95% confidence interval (CI) 1.47-12.70] at follow-up end point (P=0.01). MMC was comparable with 5-FU in qualified success rate, with a RR of 1.09 (0.99-1.20) at follow-up end point (P=0.09). MMC was comparable with 5-FU in complete success rate, with a RR of 1.17 (0.79- 1.75) at follow-up end point (P=0.43). Rates of adverse events did not differ significantly between 5-FU and MMC, with an RR of 0.71 (0.22-2.28) for bleb leakage, 1.40 (0.72-2.72) for hypotony, 1.63 (0.27-9.75) for endophthalmitis, and 0.95 (0.41-2.21) for shallow AC.


CONCLUSIONS
Intraoperative MMC is more effective in lowering IOP in trabeculectomy compared with intraoperative 5-FU, but is comparable with intraoperative 5-FU in both qualified and complete success rate. Intraoperative use of both agents may contribute equally to adverse events.
Department of Ophthalmology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
Zhong-Jie
ZJ
Lin
You
Y
Li
Jin-Wei
JW
Cheng
Xiao-He
XH
Lu
D018849:Controlled Clinical Trials as Topic; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D007430:Intraoperative Care / Q000379:methods*; D016685:Mitomycin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects
D016685:Mitomycin; D005472:Fluorouracil