Simultaneous subconjunctival and subscleral mitomycin-C application in trabeculectomy

Sayyad, Fathi El; Belmekki, Mohamed; Helal, Magdy; Khalil, Mohamed; El-Hamzawey, Hazem; Hisham, Mohamed

doi:10.1016/s0161-6420(99)00097-4

Cited by 24 publications

(23 citation statements)

References 11 publications

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“…Early studies used fixed concentrations of 0.2-0.5 mg/ml for 3-5 minute exposures and revealed uniformly high success rates with regard to IOP control and low rates of hypotony. 1,[3][4][5][6][7] Although these studies were primarily in patients who were at high risk of failure due to excessive fibrosis, other investigators have performed initial trabeculectomies in lower risk patients, using similar, fixed protocols to those described above, and also reported high success with low rates of hypotony. 8,9 In some studies, different concentrations of MMC were arbitrarily assigned to patients, while the exposure time was kept constant in all patients.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7] With it, however, came an increased risk of serious complications, including hypotony maculopathy in the early postoperative course. Many investigators have attempted to fi nd protocols for the adjunctive therapy that will provide an acceptable balance between the benefi ts and risks.…”

mentioning

confidence: 99%

“…Some surgeons have reported good results with a fi xed concentration/duration protocol for all patients, [1][2][3][4][5][6][7][8][9] while others have attempted to improve the outcome by titrating either concentration or duration according to each patient's risk for surgical failure. [10][11][12][13][14][15][16] To date, there has been no compelling evidence to support the superiority of one MMC protocol over another.…”

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confidence: 99%

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Does titration of mitomycin C as an adjunct to trabeculectomy significantly influence the intraocular pressure outcome?

Paranhos²,

2008

OPTH

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Purpose: To evaluate the benefi t of titrating the concentration and exposure time of mitomycin C (MMC) as an adjunct to trabeculectomy. Methods: This report consists of a retrospective study and a review of the literature. In the study, consecutive glaucoma patients were evaluated who underwent trabeculectomy with adjunctive MMC that was titrated for concentration and exposure time, based on patient's risk factors for surgical failure. After minimum follow-up of 6 months, patients were divided into success (intraocular pressure 7-17 mmHg), hypertension (Ͼ17 mmHg) and hypotony (Ͻ7 mmHg) groups, which were compared with regard to MMC protocol and patient variables. The literature review included reports of trabeculectomy and adjunctive MMC with and without titration. Results: One hundred and fi fty-fi ve eyes of 155 patients were studied. There were no signifi cant differences between the three outcome groups and MMC protocol (p Ͼ 0.05). The only signifi cant patient variable was older age in the hypotony group (p = 0.009). The literature is confl icting regarding the value of titrating MMC as an adjunct in trabeculectomy. Conclusion:The outcome of trabeculectomy with adjunctive MMC appears to represent a complex interaction of patient and surgical variables. While there is some support for a benefi t of titrating MMC according to individual patient variables, there is inadequate evidence at the present time to claim superiority for any MMC protocol, with or without titration.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Does titration of mitomycin C as an adjunct to trabeculectomy significantly influence the intraocular pressure outcome?

Paranhos²,

2008

OPTH

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“…Other early postoperative complications included choroidal detachment and hypotony with similar incidence rates between the groups (Table 3). In previous studies where MMC was used during phaco-trabeculectomy, a lower IOP level was found at the expense of an increased complication rate, which may be related to the dose of MMC used during surgery [5,13]. In the study of Lederer, which described the results of combined phaco-trab surgeries, a dose of 0.4 mg/ml MMC was used.…”

Section: Discussionmentioning

confidence: 99%

Results of combined phacoemulsification and trabeculectomy with mitomycin C in pseudoexfoliation versus non-pseudoexfoliation glaucoma

Landa

Pollack

Rachmiel

et al. 2005

Graefe's Arch Clin Exp Ophthalmo

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“…Several studies have suggested that the application of MCC under both flaps during trabeculectomy provides the greatest IOP reduction. 7,18 The larger the bleb area is, the better is the prognosis for success. A large area prevents the development of a ring of scar tissue, which restricts flow and promotes the development of a raised avascular bleb and late leakage.…”

Section: Discussionmentioning

confidence: 99%

Deep sclerectomy with mitomycin C in failed trabeculectomy

Rebolleda

Muñoz-Negrete

2005

Eye

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Aim To evaluate the success rate and complications associated with deep sclerectomy with mitomycin C (MMC) and a reticulated hyaluronic acid implant in previously failed trabeculectomy. Methods This prospective study included 20 eyes with a previously failed trabeculectomy, which were treated with deep sclerectomy with 0.2 mg/ml MMC application under the conjunctiva and superficial scleral flap. Intraocular pressure (IOP), glaucoma medications, visual acuity, and complications were recorded preoperatively and 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. Results The mean preoperative IOP was 25.877.3 mmHg; the IOP significantly decreased to 14.673.2 mmHg 1 year postoperative. At each interval, the mean IOP was significantly lower than preoperatively (P ¼ 0.000). At 1 year, the complete success rate (IOPr21 mmHg untreated) was 65% and the qualified success rate (IOPr21 mmHg with and without medication) was 100%. 12 patients (60%) achieved an IOPr15 mmHg with and without medication. No shallow or flat anterior chamber, endophthalmitis, or leakage developed. Conclusions These data suggest that deep sclerectomy augmented with MMC is a safe surgical procedure that decreases IOP in eyes with a previously failed trabeculectomy.

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Simultaneous subconjunctival and subscleral mitomycin-C application in trabeculectomy

Cited by 24 publications

References 11 publications

Does titration of mitomycin C as an adjunct to trabeculectomy significantly influence the intraocular pressure outcome?

Does titration of mitomycin C as an adjunct to trabeculectomy significantly influence the intraocular pressure outcome?

Results of combined phacoemulsification and trabeculectomy with mitomycin C in pseudoexfoliation versus non-pseudoexfoliation glaucoma

Deep sclerectomy with mitomycin C in failed trabeculectomy

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