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Postoperative application of mitomycin c improves the complete success rate of primary trabeculectomy: a prospective, randomized trial

  • Clinical Investigation
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Abstract

Background

The intraoperative application of mitomycin c for primary trabeculectomy is associated with potentially sight-threatening side-effects. This study was performed to evaluate the pressure-lowering effect of postoperative application of mitomycin c for primary trabeculectomy and to evaluate the complications of this new technique.

Materials and methods

A randomized, prospective clinical trial with 52 consecutive patients scheduled for glaucoma surgery in one large surgical center was performed. Patients underwent routine trabeculectomy. In group 1, mitomycin c (0.05 mg/ml) was applied topically to the filtering bleb for 5 min on the 3 days after surgery (postoperative application). In group 2, no mitomycin c was applied (controls). The IOP values, visual acuity, number of antiglaucomatous medications and complications were evaluated.

Results

Follow-up was evaluated up to 24 months for all patients. The mean intraocular pressure decreased from 31.1 to 15.4 mmHg in group 1 and from 24.8 to 15.6 mmHg in group 2 (P=0.79; t-test). The average number of medications decreased from 2.5 and 2.4 to 0.4 and 0.6 (P=0.53; t-test) in groups 1 and 2, respectively. No cases of hypotony maculopathy occurred. An individual decrease of more than 25% of the IOP was present in 84.6% in group 1 and in 53.8% in group 2 (P<0.017). Survival analysis for eyes with a complete surgical success revealed a better outcome of eyes in group 1 as compared to the eyes in group 2 (P<0.013; log-rank test).

Conclusions

To our knowledge, this is the first prospective, randomized clinical trial to evaluate the efficacy of postoperative mitomycin c application in primary trabeculectomy. The application of mitomycin significantly reduced the IOP while not increasing the rate of complications.

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References

  1. Bindlish R, Condon GP, Schlosser JD, D’Antonio J, Lauer KB, Lehrer R (2002) Efficacy and safety of mitomycin-c in primary trabeculectomy. five-year follow-up. Ophthalmology 109:1336–1342

    Article  Google Scholar 

  2. Cairns JE (1968) Trabeculectomy: preliminary report of a new method. Am J Ophthalmol 66:673–679

    PubMed  CAS  Google Scholar 

  3. Chen CW, Huang HT, Bair JS, Lee CC (1990) Trabeculectomy with simultaneous topical application of mitomycin-C in refractory glaucoma. J Ocul Pharmacol 6:175–182

    Article  PubMed  Google Scholar 

  4. Costa VP, Moster MR, Wilson RP et al (1993) Effects of topical mitomycin C on primary trabeculectomies and combined procedures. Br J Ophthalmol 77:693–697

    PubMed  CAS  Google Scholar 

  5. Gandolfi SA, Vecchi M, Braccio L (1995) Decrease of intraocular pressure after subconjunctival injection of mitomycin in human glaucoma. Arch Ophthalmol 113:582–585

    PubMed  CAS  Google Scholar 

  6. Karp CL, Higginbotham EJ, Griffin EO (1994) Adjunctive use of transconjunctival mitomycin-C in ab externo diode laser sclerostomy surgery in rabbits. Ophthalmic Surg 25:22–27

    PubMed  CAS  Google Scholar 

  7. Katz GJ, Higginbotham EJ, Lichter PR et al (1995) Mitomycin C versus 5–fluorouracil in high-risk glaucoma filtering surgery. Extended follow-up. Ophthalmology 102:1263–1269

    PubMed  CAS  Google Scholar 

  8. Kim YY, Sexton RM, Shin DH et al (1998) Outcomes of primary phakic trabeculectomies without versus with 0.5- to 1-minute versus 3- to 5-minute mitomycin C. Am J Ophthalmol 126:755–762

    Article  PubMed  CAS  Google Scholar 

  9. Kitazawa Y, Suemori-Matsushita H, Yamamoto T, Kawase K (1993) Low-dose and high-dose mitomycin trabeculectomy as an initial surgery in primary open-angle glaucoma. Ophthalmology 100:1624–1628

    PubMed  CAS  Google Scholar 

  10. Kupin TH, Juzych MS, Shin DH et al (1995) Adjunctive mitomycin C in primary trabeculectomy in phakic eyes. Am J Ophthalmol 119:30–39

    PubMed  CAS  Google Scholar 

  11. Matsuo H, Tomidokoro A, Suzuki Y, Shirato S, Araie M (2002) Late-onset transconjunctival oozing and point leak of aqueous humor from filtering bleb after trabeculectomy. Am J Ophthalmol 133:456–462

    Article  PubMed  Google Scholar 

  12. Mermoud A, Salmon JF, Murray AND (1993) Trabeculectomy with mitomycin C for refractory glaucoma in blacks. Am J Ophthalmol 116:72–78

    PubMed  CAS  Google Scholar 

  13. Mietz H, Addicks K, Diestelhorst M, Krieglstein GK (1994) Extraocular application of mitomycin C in a rabbit model: cytotoxic effects on the ciliary body and epithelium. Ophthalmic Surg 25:240–244

    PubMed  CAS  Google Scholar 

  14. Mietz H, Brunner R, Addicks K, Krieglstein GK (1993) Histopathology of an avascular filtering bleb after trabeculectomy with mitomycin-C. J Glaucoma 2: 266–270

    Article  Google Scholar 

  15. Mietz H, Raschka B, Krieglstein GK (1999) Risk factors of trabeculectomies performed without antimetabolites. Br J Ophthalmol 83:814–821

    Article  PubMed  CAS  Google Scholar 

  16. Mietz H, Jacobi PC, Krieglstein GK (2000) Postoperative application of mitomycin for trabeculectomies. Arch Ophthalmol 118:1341–1348

    PubMed  CAS  Google Scholar 

  17. Nuyts RMMA, Felten PC, Pels E et al (1994) Histopathologic effects of mitomycin C after trabeculectomy in human glaucomatous eyes with persistent hypotony. Am J Ophthalmol 118:225–237

    PubMed  CAS  Google Scholar 

  18. Palmer SS (1991) Mitomycin as adjunct chemotherapy with trabeculectomy. Ophthalmology 98:317–321

    PubMed  CAS  Google Scholar 

  19. Prata JA Jr, Minckler DS, Baerveldt G et al (1994) Site of mitomycin-C application during trabeculectomy. J Glaucoma 3:296–301

    Article  Google Scholar 

  20. Schubert HD (1996) Postsurgical hypotony: relationship to fistulization, inflammation, chorioretinal lesions, and the vitreous. Surv Ophthalmol 41:97–125

    Article  PubMed  CAS  Google Scholar 

  21. Shields MB, Scroggs MW, Sloop CM, Simmons RB (1993) Clinical and histopathologic observations concerning hypotony after trabeculectomy with adjunctive mitomycin c. Am J Ophthalmol 116:673–683

    PubMed  CAS  Google Scholar 

  22. Suner IJ, Greenfield DS, Miller MP et al (1997) Hypotony maculopathy after filtering surgery with mitomycin C. Incidence and treatment. Ophthalmology 104:207–214; discussion 214–215

    PubMed  CAS  Google Scholar 

  23. Susanna R, Costa VP, Malta RFS, Barboza WL, Vasconcellos JPC (2001) Intraoperative mitomycin-c without conjunctival and tenon’s touch in primary trabeculectomy. Ophthlamology 108:1039–1042

    Article  Google Scholar 

  24. The Fluorouracil Filtering Surgery Study Group (1996) Five-year follow-up of the Fluorouracil Filtering Surgery Study. Am J Ophthalmol 121:349–366

    Google Scholar 

  25. Tressler CS, Cyrlin MN, Rosenshein JS, Fazio R (1996) Subconjunctival versus intrascleral mitomycin-C in trabeculectomy. Ophthalmic Surg Lasers 27:661–666

    PubMed  CAS  Google Scholar 

  26. Uchida S, Suzuki Y, Araie M, Shigeeda T, Hara T, Shirato S (2001) Long-term follow-up of initial 5-fluorouracil trabeculectomy inb primary open-angle glaucoma in Japanese patients. J Glaucoma 10:458–465

    Article  PubMed  CAS  Google Scholar 

  27. Vijaya L, Mukhesh BN, Shantha B, Ramalingam S, Sathi Devi AV (2000) Comparison of low-dose intraoperative mitomycin-c vs 5-fluorouracil in primary glaucoma surgery. a pilot study. Ophthalmic Surg Lasers 31:24–30

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Aschaffenburg Eye Clinic, Aschaffenburg, Germany

    Holger Mietz

  2. Department of Ophthalmology, University of Cologne, Koeln, Germany

    Holger Mietz & Günter K. Krieglstein

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  1. Holger Mietz
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  2. Günter K. Krieglstein
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Correspondence to Holger Mietz.

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Mietz, H., Krieglstein, G.K. Postoperative application of mitomycin c improves the complete success rate of primary trabeculectomy: a prospective, randomized trial. Graefe's Arch Clin Exp Ophthalmo 244, 1429–1436 (2006). https://doi.org/10.1007/s00417-005-0217-y

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  • DOI: https://doi.org/10.1007/s00417-005-0217-y

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