A Comparison of Trabeculectomy Surgery Outcomes With Mitomycin-C Applied by Intra-Tenon Injection Versus Sponge

Lim, Michele C.; Hom, Betty; Watnik, Mitchell; Brandt, James D.; Altman, Allison R.; Paul, Tania; Tong, Melissa G.

doi:10.1016/j.ajo.2020.03.002

Cited by 19 publications

(27 citation statements)

References 32 publications

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“…Intraoperative MMC injection in intraTenon/subconjunctival space at the beginning of trabeculectomy offers several advantages. [ 7 9 10 12 15 ] However, this is a new evolving technique with limited experience. This prospective, single-surgeon, single-center study compared the IOP reduction, success rate, bleb morphology, and complication rates after subconjunctival MMC injection at the end of trabeculectomy versus intraTenon MMC injection prior to initial conjunctival incision.…”

Section: Discussionmentioning

confidence: 99%

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Comparative evaluation of outcomes of novel approach of subconjunctival Mitomycin C (MMC) injection at the end of trabeculectomy versus intraTenon injection of MMC prior to the initial conjunctival incision – A pilot study

Gupta

Beri

Rohatgi

2022

Indian Journal of Ophthalmology

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Purpose: To describe a novel approach of subconjunctival injection of mitomycin C (MMC) at the end of trabeculectomy and compare it with intraTenon MMC injection. Methods: This pilot study included 40 eyes of 40 patients with uncontrolled primary and secondary glaucoma. Patients below18 years and failed trabeculectomy were excluded. Patients were randomly allocated into groups A and B (20 patients each). Group A patients received subconjunctival MMC injection in the superonasal quadrant at the end of standard trabeculectomy. Group B received an intraTenon MMC injection before the initial conjunctival incision. Outcome measures included intra-ocular pressure (IOP) reduction, bleb morphology, and complication rates. The complete success was defined as an IOP of ≤21 mmHg without antiglaucoma drugs. Results: The mean preoperative IOP of 46.00 ± 11.2 mmHg in group A and 43.05 ± 10.3 mmHg in group B reduced to 12.00 ± 2.41 mmHg ( P ≤ 0.001) in group A and 13.65 ± 2.76 mmHg in group B ( P ≤ 0.001) at last follow-up. Complete success was 95% and 75% in groups A and B, respectively, 19 months after surgery. Avascular microcystic blebs (70% of group A and 45% of group B) were more common than avascular white blebs (15% in group A and 35% in group B). No intraoperative complications were seen. Postoperative wound leak, hypotony, choroidal detachment, or endophthalmitis were not encountered in any group. Conclusion: A novel approach of subconjunctival MMC application during trabeculectomy is reported. Both approaches appear to be highly effective in reducing IOP in primary and secondary glaucoma with similar safety profiles and bleb morphology. Subconjunctival MMC yielded a greater success rate (95%) compared to the intraTenon MMC group (75%).

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Section: Discussionmentioning

confidence: 99%

“…Lim et al . [ 15 ] noted that the proportion of eyes that achieved <22, <18, and <15 mmHg IOP at 24 months in the intraTenon MMC injection was 70.5%, 69.3%, and 66.8%, respectively. Maheshwari et al .…”

Section: Discussionmentioning

confidence: 99%

Comparative evaluation of outcomes of novel approach of subconjunctival Mitomycin C (MMC) injection at the end of trabeculectomy versus intraTenon injection of MMC prior to the initial conjunctival incision – A pilot study

Gupta

Beri

Rohatgi

2022

Indian Journal of Ophthalmology

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“…Lee et al 13 first reported intra-Tenon injection of MMC for trabeculectomies and phaco-trabeculectomies on a total of 108 cases that received different concentrations of the drug, from 0.2 to 0.5 mg/mL just before the surgery. In a follow-up study using the same technique, Lim et al 17 compared 125 trabeculectomies performed with MMC 0.1 mL of 0.05 or 0.1 mg/mL in sponges and 57 with intra-Tenon injection. Although they did not find any difference in efficacy between the groups regarding IOP reduction, a lower number of glaucoma eye drops and a number of 5-fluorouracil injections were found in the intra-Tenon injection group.…”

Section: Discussionmentioning

confidence: 99%

Glaucoma Surgery with Soaked Sponges with Mitomycin C vs Sub-Tenon Injection: Short-term Outcomes

Guimarães

Bezerra

Cordeiro

et al. 2019

Journal of Current Glaucoma Practice

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AimThe aim of this study is to compare the outcomes, success rates, complications, and number of interventions of the trabeculectomy surgery with mitomycin C (MMC) in two different techniques: conventional soaked sponges and sub-Tenon injection.Materials and methodsAn observational retrospective study was performed with 79 eyes of 64 participants who underwent a glaucoma surgery with MMC. The conventional sponge soaked with MMC 0.03% for 3 minutes over the scleral flap (group I) and the subtenon injection of 0.1 mL of MMC 0.03% (group II) techniques were used to deliver the MMC. The data collected were patient demographics, preoperative intraocular pressure (IOP), central corneal thickness (CCT), number of pre- and postoperative ocular hypotensive drugs, postoperative complications, number of interventions, and need of further glaucoma surgery.ResultsSeventy-nine eyes were divided into two: 39 eyes (49.37%) in group I and 40 eyes (50.63%) in group II. Trabeculectomy was performed in 53.17% and phacotrabeculectomy in 46.83%. The IOP decreased from 18.0 ± 11.0 mm Hg at the baseline to 10.0 ± 3.0 mm Hg at the last visit in group I and, in group II, from 16.0 ± 10.0–13.0 ± 6.0 mm Hg (median ± ID), p < 0.001. There were no significant differences between the groups regarding demographics, median follow-up, IOP in baseline, CCT, drugs reduction, success criteria adopted, postsurgical interventions, surgical complications, and need for new procedures (p > 0.05).ConclusionSub-Tenon injection of MMC is a safe and as effective as the conventional soaked sponge method in trabeculectomies. This method reduces surgical time and sponge-related risks with equivalent surgical efficacy.Clinical significanceAs trabeculectomy is still the most common surgical procedure to reduce IOP and scar formation is one of the main causes of surgical failure, it is important to develop surgical techniques to improve its outcomes.How to cite this articleGuimarães MEV, de Pádua Soares Bezerra B, et al. Glaucoma Surgery with Soaked Sponges with Mitomycin C vs Sub-Tenon Injection: Short-term Outcomes. J Curr Glaucoma Pract 2019;13(2):50–54.

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“…This method is widely known and accepted by glaucoma surgeons as the dose is more titratably delivered compared to the variability with sponge delivery, and the application area is more diffuse, which promotes a more diffuse posterior bleb with more time-saving. [181920]…”

Section: Discussionmentioning

confidence: 99%

One-year results of stab incision glaucoma surgery and radiofrequency-assisted stab incision in management of open-angle glaucoma

Salama

Abdel-Hamid

Elbasty

et al. 2019

Middle East Afr J Ophthalmol

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PURPOSE:The aim of the study is to evaluate the surgical outcome of stab incision glaucoma surgery (SIGS) and compare it with radiofrequency-assisted stab incision in the treatment of uncontrolled open-angle glaucoma.PATIENTS AND METHODS:A prospective, interventional study included 50 eyes who were assigned into two equal groups: Group A underwent stab incision procedure with preoperative subconjunctival (SC) mitomycin-C (MMC) and Group B underwent radiofrequency-assisted technique without MMC. Intraoperative and postoperative complications, visual acuity, intraocular pressure (IOP), and bleb status were evaluated up to 12 months.RESULTS:Mean preoperative IOP in Group A was 26.96 ± 2.42 reduced to 13.43 ± 2.31 while in Group B was 27.20 ± 3.57 reduced to 15.48 ± 3.68 mmHg (P < 0.001) with a mean reduction of 50.61% ± 8.42% and 43.56% ± 12.83%, 12 months postoperatively in Groups A and B, respectively. Non-basal peripheral iridectomy was the most encountered intraoperative complication in 8 eyes (32%) and 9 eyes (36%) and hypotony was the most reported postoperative complication in 5 eyes (20%) and 9 eyes (36%) in Groups A and B, respectively. Flat bleb area had been reported at the end of follow-up time in 3 eyes (13%) and 7 eyes (30%) in Groups A and B, respectively. Complete success rate was 52.2% and 28.6% while qualified success rate was 28.8% and 42.9% in Groups A and B, respectively.CONCLUSION:SIGS with SC MMC is an effective and safe procedure in IOP lowering, while radiofrequency-assisted stab incision had high incidence of subconjunctival scarring and ostium closure.

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A Comparison of Trabeculectomy Surgery Outcomes With Mitomycin-C Applied by Intra-Tenon Injection Versus Sponge

Cited by 19 publications

References 32 publications

Comparative evaluation of outcomes of novel approach of subconjunctival Mitomycin C (MMC) injection at the end of trabeculectomy versus intraTenon injection of MMC prior to the initial conjunctival incision – A pilot study

Comparative evaluation of outcomes of novel approach of subconjunctival Mitomycin C (MMC) injection at the end of trabeculectomy versus intraTenon injection of MMC prior to the initial conjunctival incision – A pilot study

Glaucoma Surgery with Soaked Sponges with Mitomycin C vs Sub-Tenon Injection: Short-term Outcomes

One-year results of stab incision glaucoma surgery and radiofrequency-assisted stab incision in management of open-angle glaucoma

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