Intra-operative Mitomycin C for glaucoma surgery

Wilkins, Mark R; Indar, Andrea; Wormald, Richard

doi:10.1002/14651858.cd002897

Cited by 114 publications

(138 citation statements)

References 38 publications

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“…16 Various studies demonstrated significant enhancement of success rates and postoperative IOP through intraoperative use of MMC. 3 This was accompanied by an increase in adverse effects such as cataract formation, avascular filtering blebs, thinning of the conjunctiva, subsequent blebitis, and endophthalmitis. [3][4][5][6] The current focus is on the development of less toxic agents and implants to inhibit cicatrisation without adverse effects.…”

Section: Discussionmentioning

confidence: 99%

“…3 This was accompanied by an increase in adverse effects such as cataract formation, avascular filtering blebs, thinning of the conjunctiva, subsequent blebitis, and endophthalmitis. [3][4][5][6] The current focus is on the development of less toxic agents and implants to inhibit cicatrisation without adverse effects. One approach is the development of biodegradable implants to serve as a placeholder and prevent conjunctiva-sclera adhesion.…”

Section: Discussionmentioning

confidence: 99%

“…1 Adjunctive anti-fibrotic agents such as 5-fluorourail or mitomycin C (MMC) have a potent inhibitory effect on postoperative scarring and a positive effect on surgical success rates. 2,3 Although the risk profile of additional use of MMC in trabeculectomy appears low, some side effects such as cataract formation, avascular filtering blebs, thinning of the conjunctiva, subsequent blebitis, and endophthalmitis have been described. [3][4][5][6] Recently, tissue-engineered biodegradable implants have been created as an alternative augmentation in trabeculectomy.…”

Section: Introductionmentioning

confidence: 99%

“…2,3 Although the risk profile of additional use of MMC in trabeculectomy appears low, some side effects such as cataract formation, avascular filtering blebs, thinning of the conjunctiva, subsequent blebitis, and endophthalmitis have been described. [3][4][5][6] Recently, tissue-engineered biodegradable implants have been created as an alternative augmentation in trabeculectomy. Tissue engineering involves the combination of a polymer scaffold with a population of stem, progenitor, or precursor cells.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

A prospective randomised trial of trabeculectomy using mitomycin C vs an ologen implant in open angle glaucoma

Rosentreter

Schild

Jordan

et al. 2010

Eye

107

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A prospective randomised trial of trabeculectomy using mitomycin C vs an ologen implant in open angle glaucoma

Rosentreter

Schild

Jordan

et al. 2010

Eye

107

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“…Spontaneous late bleb leaks occur more frequently in glaucoma filtering surgery following adjunctive use of antimetabolites. 15,16 These leaks may be uncomplicated and self-limiting or may be associated with sight-threatening complications. The plethora of treatment options for management of bleb leaks described in the literature [17][18][19][20][21][22] reflects the widespread nature of this problem.…”

Section: Introductionmentioning

confidence: 99%

Early bleb leak after trabeculectomy and prognosis for bleb failure

Alwitry

Rotchford

Patel

et al. 2008

Eye

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Aim To determine whether early bleb leak after MMC trabeculectomy affects intermediate intraocular pressure (IOP) outcome. Methods Retrospective case note review. All cases of MMC trabeculectomy with at least 1-year follow-up were included. Cases where a bleb leak occurred within the first month were identified. All cases without an early bleb leak formed the control group. Patient demographics and clinical factors were analysed to determine any factors predisposing to bleb leakage. IOPs were compared for 1 year postoperatively and final follow-up. Results A total of 119 trabeculectomies were included. Of these 27 (22.7%) had an early bleb leak. The remaining 92 cases formed the control group. Mean age of cases was 70.7 years. Mean follow-up time was 19.5 months. Mean time of detection of the bleb leak was 9 days (range 1-21 days). Four cases (14.8%) were managed by primary resuturing. Thirteen cases (48.1%) were managed conservatively with a bandage contact lens. Ten cases (37.0%) resolved with expectant management. There was no statistically significant difference between the two groups with regards to IOP measurement at any time point. Intervention rates were similar with regards to bleb massage, 5-fluorouracil injection, and needling revision. No factors were identified between the two groups that predisposed to bleb leaks occurring. Conclusion Our data suggest that early bleb leak is not a poor prognostic indicator for intermediate bleb survival and IOP control in patients undergoing MMC trabeculectomy. No additional bleb manipulations compared with the control group were required to achieve a satisfactory IOP outcome.

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Efficacy and Safety of Trabeculectomy vs Nonpenetrating Surgical Procedures

et al. 2013

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IMPORTANCETo date, only a few studies have directly compared nonpenetrating surgery (NPS) and trabeculectomy (TE). Therefore, there is no strong evidence as to which surgical technique leads to the best results in terms of ocular hypotensive effect and safety.OBJECTIVE To compare the hypotensive effect and safety of NPS and TE in terms of intraocular pressure (IOP) reduction and incidence of complications.DATA SOURCES The MEDLINE and EMBASE databases were searched for studies potentially eligible in any language published up to March 31, 2013.STUDY SELECTION Systematic review and meta-analysis of comparative studies of 2 or more surgical techniques (1 of which had to be TE), including patients with open-angle glaucoma. DATA EXTRACTION AND SYNTHESISThe considered interventions were TE, deep sclerectomy (DS), viscocanalostomy, and canaloplasty. MAIN OUTCOMES AND MEASURESThe primary outcome was the mean between-group difference in the reduction in diurnal IOP from baseline to the 6-or 12-month follow-up evaluation. We also considered the incidence of complications, expressed as relative risk.RESULTS Eighteen articles, accounting for 20 comparisons, were selected for data extraction and analysis. Analysis of the 6-month follow-up data showed that the pooled estimate of the mean between-group difference was −2.15 mm Hg (95% CI, −2.85 to −1.44) in favor of TE. There was no difference between the NPS subgroups. In the subgroup antimetabolite analysis, the addition of mitomycin C to TE and DS decreased the difference in the reduction in IOP (TE and DS without mitomycin C: −2.65 mm Hg [95% CI, −3.90 to −1.39]; TE and DS with mitomycin C: −0.83 mm Hg [95% CI, −2.40 to 0.74]). In the subgroup analysis by implant addition, no significant difference induced by DS with or without drainage devices was detected (test for subgroup differences: χ 2 1 = 0.24; P = .62). The absolute risk of hypotony, choroidal effusion, cataract, and flat or shallow anterior chamber was higher in the TE group than in the NPS group. CONCLUSIONS AND RELEVANCE Trabeculectomy seems to be the most effective surgical procedure for reducing IOP in patients with open-angle glaucoma. However, as expected, it was associated with a higher incidence of complications when compared with NPS.

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Intra-operative Mitomycin C for glaucoma surgery

Cited by 114 publications

References 38 publications

A prospective randomised trial of trabeculectomy using mitomycin C vs an ologen implant in open angle glaucoma

A prospective randomised trial of trabeculectomy using mitomycin C vs an ologen implant in open angle glaucoma

Early bleb leak after trabeculectomy and prognosis for bleb failure

Efficacy and Safety of Trabeculectomy vs Nonpenetrating Surgical Procedures

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