Effect of Intraoperative Mitomycin C on the Surgical Outcomes of Ahmed Glaucoma Valve Implantation with Ciliary Sulcus Tube Placement

Abstract

Purpose: To evaluate the effect of intraoperative mitomycin C (MMC) on the surgical outcomes of ciliary sulcus (CS) Ahmed glaucoma valve (AGV) tube placement.Methods: A retrospective review of medical records of 54 consecutive patients who underwent AGV implantation with tube placed in CS was performed. Consecutive cases operated without the use of intraoperative MMC from 2017 to 2019 were compared with consecutive cases operated with MMC from 2019 to 2021. Surgical failure was defined as intraocular pressure (IOP) exceeding 21 mmHg in two consecutive visits after postoperative 3 months or ≤30% IOP reduction, IOP ≤5 mmHg in two consecutive visits, or loss of light perception. Kaplan-Meier survival analysis and log-rank test were performed to compare the surgical failure rates.Results: A total of 54 eyes of 54 patients were investigated. Mean follow-up period after AGV implantation was 1.4 ± 0.8 years. The MMC group showed significantly lower IOP during the 1st postoperative month (20.5 ± 8.6 mmHg vs. 15.8 ± 6.4 mmHg, <i>p</i> = 0.027), but the difference did not persist 6 months after the surgery (<i>p</i> = 0.805). The mean number of postoperative antiglaucoma medications was significantly lower in the MMC group in the 1st postoperative month (<i>p</i> = 0.047) but no difference was found at 6 months. No statistical difference was noted in the rates of postoperative complications. Kaplan-Meier survival analysis showed comparable survival rates between MMC group and no MMC group (<i>p</i> = 0.356).Conclusions: The intraoperative use of MMC significantly lowered IOP in the 1st postoperative month but did not increase 6 months success rates in patients receiving AGV tube placement in CS.

Glaucoma surgical procedures under development

“…In addition to new implants, advancements in bleb surgery have also focused on improving the success of tube surgery and preventing bleb scarring and failure. Several recent studies have evaluated the use of MMC in tube surgery (a topic on which there is no consensus, despite prior studies, see Cantor et al ) [24][25][26]. A prospective, single-center, randomized study of 56 eyes was performed to compare intraoperative injection of mitomycin C (0.15 ml of 0.01%) versus 2-min application of 0.02% soaked sponges during trabeculectomy [27].…”

Ahmed Glaucoma Valve Implantation to Reduce Intraocular Pressure: Updated Perspectives

“…Its effectiveness and safety has been demonstrated in some previous reports. [32][33][34][35]66 Ciliary sulcus tube shunt placement was first described by Rumelt and Rehany in 1998. 66 They performed this surgical approach in 3 patients with corneal grafts.…”

“…To date, the results of ciliary sulcus tube shunt placement was evaluated in various studies and success rates were reported as high as 78.6% to 98.3%. [32][33][34][35] Eslami et al 34 evaluated retrospectively the results of 23 eyes of 23 patients that underwent AGV tube implantation into the ciliary sulcus. In the study the mean follow-up period was 9 months (range 3-24 months) and IOP reduced from 37.9 ± 12.4 mmHg to 16.2 ± 3.6 mmHg at last follow-up visit and the success rate was found as 78.6%.…”