MMC boost for trabeculectomy

Perioperative use of mitomycin-C (MMC) improves the long-term outcomes of trabeculectomy as a treatment for primary open-angle glaucoma (POAG), according to a study published online ahead of print by the British Journal of Ophthalmology.

Antonio Longo of the Eye Clinic at the University of Catania, Italy and colleagues conducted a retrospective chart review of subjects suffering from POAG (n=114) who were involved in a randomized clinical trial (held 1995–1998) in which they underwent trabeculectomy in one eye and received a intraoperative dose of either MMC 0.2 mg/ml (n=67) or balanced saline solution (BSS; n=47).

Eyes treated with MMC had a mean intraocular pressure (IOP) value of 13.33±3.35 mmHg, compared with a mean IOP of 14.72±2.19 mmHg in the BSS group. In the MMC-treated group, 73.1% of subjects had IOP ≤18 mmHg and 56.7% of subjects had IOP ≥14 mmHg; in the BSS group, this was 51.1% and 31.9% of patients, respectively. Only 9% of MMC-treated patients required further glaucoma surgery, compared with 25.5% of BSS-treated patients. The damage to the visual field progressed in 21.1% of MMC-treated patients, compared with 48.6% of BSS-treated patients. In terms of the incidence of complications, there was no difference seen between groups, although one eye treated with MMC went on to develop blebitis.

Thus the team concluded that using MMC during trabeculectomy did not increase the rate of complications. It did, however, improve IOP outcomes and decrease the risk of both further visual field damage and repeated surgical interventions.