Historical Considerations and Innovations in the Perioperative Use of Mitomycin C for Glaucoma Filtration Surgery and Bleb Revisions

Abstract

Although there is a currently a revolution in angle-based procedures, subconjunctival filtration surgery with mitomycin C (MMC) wound modification remains a vital skill for glaucoma surgeons. MMC is a potent antifibrotic agent that has been an invaluable adjunct for successful glaucoma filtration surgery for over 20 years, but it must be used judiciously to avoid serious complications, including hypotony, corneal decompensation, bleb avascularity, bleb leaks, blebitis, and endophthalmitis. The purpose of this report is to describe the historical lessons learned from MMC use, along with updated methods of MMC delivery during primary trabeculectomy, bleb needling at the slit lamp, bleb revisions in the operating room, and newer and less invasive ab-interno filtering procedures. Information for the review was gathered using an extensive search on PubMed, a review of all available peer-reviewed literature, and the authors’ personal clinical judgment and experience.

Effects of Valproic Acid and Mitomycin C Combination Therapy in a Rabbit Model of Minimally Invasive Glaucoma Surgery

“… 10 Hence, a long-lasting healthy bleb will preferably retain some vascularity while avoiding the excessive vascularization that has frequently been associated with surgical failure. 32 Here, we show that the application of low-dose MMC reduced bleb avascularity compared with high-dose MMC, but the addition of VPA went further by seemingly supporting the survival of the vasculature without an apparent increase in vascularization. Indeed, VPA is known to activate cell survival signaling pathways, 33 provide cytoprotective effects in lethal hemorrhage, 34 and preserve endothelial function in a model of severe traumatic shock.…”

Phacotrabeculectomy vs Phacoemulsification Glaucoma coexist Cataracts: a Meta-analysis of randomized controlled trials

“…In ammation postoperatively in Phacotrabeculectomy is more serious than Phacoemulsi cation, and more prone to ltering bleb failure. Today, anti-metabolic chemicals such as mitomycin C can reduce broblast collagen synthesis and inhibit cell migration and extracellular matrix production so that used widespread [14], but it is hard to Legend not included with this version.…”

Outcome of Trabeculectomy with Intraoperative Subtenon Injection of Mitomycin C

“…By injecting the MMC, one also eliminates the risk of intraoperative sponge loss 22 . One of the concerns raised by Grower et al 23 for injection technique was that by using the ne needle to inject MMC superiorly, one can pierce the sclera or this may cause conjunctival leak postoperatively. In our surgical method as we enter with blunt canula at limbus, these complications are bypassed.…”