The Short-term Effect of Subtenon Sponge Application Versus Subtenon Irrigation of Mitomycin-C on the Outcomes of Trabeculectomy With Ex-PRESS Glaucoma Filtration Device: A Randomized Trial

Abstract

Application of subtenon MMC by irrigation seems to provide improved short-term outcomes compared with application with sponges. With a similar safety profile, the irrigation method provides better IOP control, and decreases the need for further clinical/surgical intervention in the short-term after trabeculectomy. Longer-term studies will be useful in analyzing if these differences persist with time.

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

“…Other studies of MMC injection or irrigation with trabeculectomy surgery in human eyes likewise show similar mean IOP outcomes in comparison to sponge groups as well as no statistically significant difference in success rate of IOP control. 21,23,27 However, 1 study did find a significantly greater change in IOP from baseline in the MMC irrigation group at postoperative month 6 in comparison to the MMC sponge group in eyes treated with trabeculectomy and EX-PRESS shunt. 23 Our study revealed a surprising finding in that trabeculectomy surgeries performed with limbus-based conjunctival incisions had a longer time to failure for IOP control.…”

“…21,23,27 However, 1 study did find a significantly greater change in IOP from baseline in the MMC irrigation group at postoperative month 6 in comparison to the MMC sponge group in eyes treated with trabeculectomy and EX-PRESS shunt. 23 Our study revealed a surprising finding in that trabeculectomy surgeries performed with limbus-based conjunctival incisions had a longer time to failure for IOP control. The literature regarding the effect of conjunctival incision type on post-trabeculectomy IOP outcomes is mixed.…”

“…A greater rate of hypotony maculopathy was noted in the MMC injection group early but not late. Quist and associates 23 found a higher proportion of hypotony in the MMC irrigation group but not hypotony maculopathy, while Pakravan and associates 21 and Khouri and associates 27 found no difference for this particular complication. Among 4 recent publications comparing MMC delivered by sponge vs injection or irrigation, no differences in complications were found for bleb leak, choroidal effusions, suprachoroidal hemorrhage, overfiltration, or infection.…”

“…Among 4 recent publications comparing MMC delivered by sponge vs injection or irrigation, no differences in complications were found for bleb leak, choroidal effusions, suprachoroidal hemorrhage, overfiltration, or infection. [21][22][23]27 Only 1 study to date has investigated endothelial cell count (ECC) before and after trabeculectomy surgery with MMC delivered by sponge vs injection. In this prospective, randomized investigation, eyes randomized to MMC injection had a preoperative ECC of 2843 6 391 and eyes randomized to MMC delivered by sponge had an ECC of 2875 6 374 (P ¼ .858).…”

“…Another novel method of applying MMC diffusely is by injection or irrigation of MMC into the Tenonlayer; this has been studied in animal 19,20 and in human [21][22][23] eyes. In 1 study using rabbit eyes, MMC applied by injection into conjunctiva was compared to 3 other methods: application with a regular surgical sponge, a scleral shield, and a presoaked soft contact lens.…”