A Modified Technique in Applying Sponge Soaked with Mitomycin C in Trabeculectomy

Abstract

Trabeculectomy with adjunctive use of Mitomycin C (MMC) has been a benchmark for glaucoma filtration surgery for decades. However, there are many variations in the ways that the sponges soaked with MMC are applied during the trabeculectomy surgery. We herein describe our way of placing the MMC-soaked sponges to improve the safety and efficacy of the trabeculectomy. The sponges are placed vertically and posteriorly with the long side of the sponge perpendicular to the limbus, not parallel. This will reduce the size of the conjunctival wound at the limbus to preserve more virgin conjunctiva that can be used for repeated trabeculectomy when needed. This will also facilitate a more posteriorly directed flow of aqueous drainage that, in turn, may increase the success rate of the trabeculectomy. We have obtained encouraging results in our practice, and further large-scale randomized studies seem warranted.

Safety and Efficacy of Posterior Scleral Application of Mitomycin C-Soaked Sponge in Trabeculectomy

“…Reducing the size of the conjunctival wound at the limbus can preserve more conjunctiva for reoperation, if required (ref. 12), particularly for patients at high risk of failure.…”

“…A piece of 3.5 mm × 10 mm MMC-soaked sponge (0.2-0.5 mg/ml) was made by trimming the Medical Absorbent Pad (Winner, Guangdong, China) (ref. 12). The sponge was inserted vertically and posteriorly into the sub-Tenon space (Fig.…”

“…The videos of detailed surgical techniques were shown in two links provided in prior study, (ref. 12) https://links.lww.com/APJO/A107 and https://links.lww.com/APJO/A108. After 1-5 min, the sponges were removed, and the scleral bed was irrigated with 150-200 ml of balanced salt solution.…”

“…We previously proposed a modi ed technique, posterior scleral application of the MMC-soaked sponge with reduced the size of the conjunctival wound in trabeculectomy, which entails vertical and posterior placement of MMC-soaked sponge within the sub-Tenon space under the scleral ap (ref. 12). The current study evaluated the safety and e cacy of the modi ed trabeculectomy in which the MMC is applied to the sclera more posteriorly than usual.…”

A Comprehensive Review of Pediatric Glaucoma Following Cataract Surgery and Progress in Treatment

“…Antimetabolites, such as MMC and 5-fluorouracil, are generally used to suppress fibrosis and vascular ingrowth after exposure to the filtration site during trabeculectomy and CTT. 23,[80][81][82][83][84][85][86][87][88] Among these studies, the success rate of the study with the largest sample size (n = 61) was only 24.6% after a mean follow-up of 8.6 years. 23 These findings suggest that trabeculectomy has an unsatisfactory effect on GFCS, even with the intraoperative use of antimetabolites, especially in younger patients, because of increased fibrotic activity and rapid wound healing response.…”