One-Year Randomized Comparison of Safety and Efficacy of Trabeculectomy with Mitomycin C Sub-Tenon Injection versus Mitomycin C-Infused Sponges

Kandarakis, Stylianos; Papakonstantinou, Evangelia; Petrou, Petros; Diagourtas, Andreas; Ifantides, Cristos; Georgalas, Ilias; Serle, Janet B.

doi:10.1016/j.ogla.2021.05.006

Cited by 15 publications

(16 citation statements)

References 34 publications

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“…In our study, the complete success rate was 47.6% in the sponge group and 59.1%in the injection group at the end of three years. Kaplan Meier survival analysis which was used to compare the cumulative probability of success between the two groups revealed an overall success of 70.7% in the sponge group and 75.3% in the injection group at the end of three years.This is consistent with previous trials which also reported comparable success with the two modalities of Mitomycin application 10,11,15 Although complication rates were similar in both the groups,the incidence of choroidal detachments and conjunctival retraction were more in the sponge group. Several previous studies suggest that intraoperative subconjunctival injection of MMC is not associated with increased risk.…”

Section: Discussionsupporting

confidence: 91%

“…These include the reduced risk of unwanted exposure of areas of the conjunctiva and limbal epithelium to MMC, less conjunctival damage during manipulation of MMC soaked sponge and eliminating the risk of inadvertently retained sponge material 23 .It also allows the administration of a more precise dose of MMC, whereas MMC soaked sponges have been shown to have high intra and inter observer variability in quanti cation 24,25 . Sub conjunctival injection of MMC also offers a better coverage area from subconjunctival dissipation and can thus result in better bleb morphology and ltering function 11 . In our study, we used a similar concentration of MMC in both the groups (0.1 ml of 0.2 mg /ml).This was similar to the study by Khouri 14 In our study, there was a statistically signi cant reduction of IOP from the baseline in both the groups.…”

Section: Discussionmentioning

confidence: 99%

“…Another technique that has gained momentum is the application of subconjunctival injection of MMC, which is reported to have good surgical outcomes [9][10][11][12][13][14][15][16][17] . However, out of these very few studies were randomised 10,11,15 and studies with long-term follow-up are sparse 15 (Table 1). Our prospective, randomized study aimed to compare the two modalities of MMC application and study the effects over a long term of three years.…”

Section: Introductionmentioning

confidence: 99%

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Long-term Outcomes Of Mitomycin-C Augmented Trabeculectomy using Subconjunctival Injections Versus Soaked Sponges: A Randomized Controlled Trial

Maheshwari

Pillai²,

HM³

et al. 2023

Preprint

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Purpose: To compare the safety and efficacy of subconjunctival injection of Mitomycin C(MMC) with sponge-applied MMC during trabeculectomy. Methods: This prospective, randomized, interventional study was conducted on consecutive patients with uncontrolled glaucoma. 137 patients were randomized into an Injection group(Group 1,n=66) and a sponge group(Group 2,n=71). Trabeculectomy was performed in all patients who were followed up on days 1, 15, 30, 3 months,6 months,1 year,2 years & 3 years postoperatively. Baseline & follow-up visits were compared to find out difference in the number of antiglaucoma medications (AGM ), Intraocular pressure(IOP), and Best Corrected Visual Acuity(BCVA).In Group 1, the surgeon used MMC 0.2 mg/ml as subconjunctival injection and two separate semicircular surgical sponges soaked with MMC solution of 0.2 mg/mL were inserted subconjunctivally in Group 2. Results:Mean preop IOP was 34.21±13.3mmHg& 34.17±10.6mmHg in group 1&2 respectively,which reduced to 11.34±3.7& 12.57±4.7mmHg(6 months),11.97±4.2& 13.60 ±5.3mmHg(1year),12.42±4.4& 11.77±2.8 mmHg(2years)&11.25±3.2&11.81±3.2mmHg at final visit(P<0.001 in both groups)with no significant difference between the groups.The mean number of preoperative AGM was 2.32±0.7&2.32±0.8 in group1&2 respectively which reduced to 0.78±0.9(P<0.001)&1.13±1.1(P=0.930)at 3 years.Overall success rates were 75.3% in group 1 and 70.7% in group 2 at 3 years(p=0.512). Postoperative complications and the final post-operative visual outcomes were similar between the groups. Conclusion: Subconjunctival Injection of MMC is as safe and effective as sponge application with comparable surgical outcomes and complications in the long term.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long-term Outcomes Of Mitomycin-C Augmented Trabeculectomy using Subconjunctival Injections Versus Soaked Sponges: A Randomized Controlled Trial

Maheshwari

Pillai²,

HM³

et al. 2023

Preprint

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“…In an RCT, Do et al demonstrated that preoperative subconjunctival injection of MMC and intraoperative direct scleral application of MMC with surgical sponges resulted in comparable surgical outcomes [ 118 ]. However, some studies suggest that sub-Tenon injection of MMC produces more favorable bleb morphology after trabeculectomy [ 44 , 45 , 46 ]. Methods and dosage articles have been recently reviewed elsewhere by Bell et al Due to the greater potency of MMC, intraoperative application of MMC has become popular with adjunctive postoperative 5-FU [ 42 ].…”

Section: Strategies To Prevent Ocular Fibrosis Following Glaucoma Fil...mentioning

confidence: 99%

Novel Therapies for the Prevention of Fibrosis in Glaucoma Filtration Surgery

et al. 2023

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Conjunctival fibrosis remains the major impediment to the success of glaucoma filtration surgery. Anti-metabolites remain the gold standard for mitigating post-surgical fibrosis, but they are associated with high complication rates and surgical failure rates. Establishing a more targeted approach to attenuate conjunctival fibrosis may revolutionize the surgical approach to glaucoma. A new strategy is needed to prevent progressive tissue remodeling and formation of a fibrotic scar, subsequently increasing surgical success and reducing the prevalence of glaucoma-related vision loss. Advancements in our understanding of molecular signaling and biomechanical cues in the conjunctival tissue architecture are broadening the horizon for new therapies and biomaterials for the mitigation of fibrosis. This review aims to highlight the strategies and current state of promising future approaches for targeting fibrosis in glaucoma filtration surgery.

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“…Glaucoma filtration surgery (GFS) remains one of the major procedures within the glaucoma surgeons armamentarium to surgically reduce intraocular pressure (IOP), restrain the progression of glaucomatous optic neuropathy, and prevent further visual field loss [ 1 ]. While newer techniques and minimally invasive procedures have gained popularity among anterior segment surgeons, trabeculectomy still has a leading role in surgical intervention and retains a highly successful and safe profile [ 1 , 2 ]. One of the major complications following GFS is bleb-related infections (BRI), which may compromise surgical success and increase the risk of poor post-surgical vision [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

A Review on Pathogens and Necessary Diagnostic Work for Bleb-Related Infections (BRIs)

et al. 2022

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At the present time, as newer techniques and minimally invasive procedures gain popularity among anterior segment surgeons for regulating intraocular pressure, trabeculectomy still has a leading role in glaucoma surgery. Trabeculectomy retains a highly successful and safe profile; however, one of the major complications includes bleb-related infections (BRIs). To date, the most common pathogens remain Gram-positive cocci, but the list of pathogens that have been identified in the literature includes more than 100 microorganisms. Because antibiotic use is more widespread than ever before and our ability to identify pathogens has improved, the pathogen spectrum will broaden in the future and more pathogens causing BRIs will be described as atypical presentations. The scope of this review was to identify all pathogens that have been described to cause bleb-related infections to date, as well as focus on the risk factors, clinical presentation, and various available diagnostic tools used for an appropriate diagnostic workup.

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One-Year Randomized Comparison of Safety and Efficacy of Trabeculectomy with Mitomycin C Sub-Tenon Injection versus Mitomycin C-Infused Sponges

Cited by 15 publications

References 34 publications

Long-term Outcomes Of Mitomycin-C Augmented Trabeculectomy using Subconjunctival Injections Versus Soaked Sponges: A Randomized Controlled Trial

Long-term Outcomes Of Mitomycin-C Augmented Trabeculectomy using Subconjunctival Injections Versus Soaked Sponges: A Randomized Controlled Trial

Novel Therapies for the Prevention of Fibrosis in Glaucoma Filtration Surgery

A Review on Pathogens and Necessary Diagnostic Work for Bleb-Related Infections (BRIs)

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