title: Epiconjunctival mitomycin-C application for early failing filtering blebs.
abstract: OBJECTIVE
  To evaluate the effectiveness of epiconjunctival Mitomycin-C (MMC) application in early failing filtering blebs.
  
  
  METHODS
  Interventional case series.
  
  
  METHODS
  Patients with failing blebs and raised intraocular pressure (IOP) in the early (two weeks to one month) postoperative period following glaucoma filtering surgery.
  
  
  METHODS
  A retrospective analysis of records of failed blebs was done for the period of April 2011-March 2012. Patients who were subjected to three applications of MMC (0.04%) applied over the conjunctiva directly over the bleb at baseline (visit1), one week (visit 2) and at one month (visit 3) were included. Bleb characteristics were graded in a blinded fashion by one independent ophthalmologist, while IOP during follow-up visits were analyzed.
  
  
  METHODS
  Intraocular pressure, need for additional measure, or medications and bleb characteristics as graded by Indiana classification.
  
  
  RESULTS
  Ten eyes of nine patients with failing blebs received topical MMC, including included eight males and one female with a mean age of 52 ± 18 years (trabeculectomy:combined surgery = 5:5). Complete success was seen in eight of 10 eyes with a final mean IOP of 14 ± 2.9 mm Hg at three months. Excluding the two eyes that required medications, IOP reduction of 9%-42% was seen at visit 2, 16-57% IOP reduction at visit 3, and 16-56% at three months' follow-up. Of eight eyes, all eyes showed decrease in vascularity of the blebs, p < 0.001. While the height of the blebs did not show significant increase, all had increase in the avascular area of the bleb. One eye developed spontaneously resolving adenoviral conjunctivitis without any sequelae.
  
  
  CONCLUSIONS
  Three applications of epiconjunctival MMC may be a safe alternative for salvaging failing blebs in the early postoperative period. This may help maximize anti-fibrotic effect of MMC while minimizing complications by limiting the area of contact.
authors: Glaucoma Services, L.V. Prasad Eye Institute , Patia, Bhubaneswar, Odisha , India.
authors: Aparna
authors: A
authors: Rao
authors: Sushanta
authors: S
authors: Chatterjee
mesh_terms: D000477:Alkylating Agents / Q000008:administration & dosage*; D003228:Conjunctiva / Q000187:drug effects* / Q000601:surgery; D005260:Female; D005355:Fibrosis / Q000517:prevention & control; D005901:Glaucoma / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D012189:Retrospective Studies; D019738:Surgically-Created Structures; D014130:Trabeculectomy; D014792:Visual Acuity / Q000502:physiology; D014945:Wound Healing / Q000187:drug effects*
chemical_list: D000477:Alkylating Agents; D016685:Mitomycin