The use of intraoperative application of Mitomycin C at the filtration site has been known to improve the surgical outcome in glaucomatous eyes with high risk for failure of trabeculectomy.
The author performed trabeculectomies with intraoperative Mitomycin C on 25 eyes of 20 patients with poor surgical prognosis to study the efficacy and safety of this technique in glaucomatous patients with high risk for failure of trabeculectomy.
After
the preparation of a scleral flap, 0.2mg/ml sulution of Mitomycin C was applied between Tenon's capsule and the sclera for 2 minutes. The exposed area was then irrigated with 200 ml of balanced salt solution. The follow-up period was from 1 to 7
months
(mean 3.8 months).
The mean preoperative intraocular pressure (IOP) was 38.6±6.6mmHg. The mean final postoperative IOP was 11.7±3.8mmHg. Twenty three (88%) of the 25 eyes were successfully controlled with the IOP of less than or equal to 20 mmHg wthout glaucoma
medication.
There were early postoperative complications of hyphema in 5 eyes (20%), shallow anterior chamber in 4 eyes(16%), punctate keratopathy in 3 eyes (12%), aqueous leaking from conjunctival wound in 2 eyes (8%), encapsulated bled in 1 eye (4%) and
choroidal
detachment in 1 eye (4%), and 4 eyes had long term hypotony lasting more than 2 months. Although Mitomycin C is simple to use and effective adjunct to trabeculectomy, further study will be needed to determine the mechanism of action, indication,
dosage
and optimal exposure time of Mitomycin C.
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