To assess the advantages and adverse effects of intraoperative low-dose Mitomycin C in filtering glaucoma surgery.
Methods.
Sixty eyes of 48 patients undergoing surgery for uncontrolled glaucoma were randomized to two groups: one underwent standard trabeculectomy, the other had trabeculectomy with intraoperative application of 0.1 mg/ml mitomycin C. Follow-up was at least one year.
Results.
The success rate (IOP<18 mmHg) was 96.6% in the mitomycin C group and 73.3% in the control group. Mean IOP at one year of successful cases was 11.1 ± 3.1 mmHg in the mitomycin C group and 16.4 ± 6.1 mmHg in controls (p<0.0001). Two patients in the mitomycin C group (6.6%) and six (20%) in the control group needed antiglaucomatous drugs to keep IOP below 18 mmHg.
Conclusions.
Mitomycin C is a useful adjunct to glaucoma surgery. Adverse effects at the dosage used are mainly due to hypotony and are preventable with two-layer suture. Low-dose mitomycin C may be useful in standard primary trabeculectomy.
AndersonD.R.Glaucoma: the damage caused by pressure. Jackson Memorial Lecture.Am J Ophthalmol1989; 108: 485–95.
2.
PalmbergP.F.The rationale and effectiveness of glaucoma therapy.Am Glaucoma Society, Miami (Fl), Dic.1988.
3.
OdbergT.Visual field prognosis in advanced glaucoma.Acta Ophthalmol1987; 65(Suppl 182): S27–S29.
4.
HitchingsR.A., MigdalC.S., FitzkeF.Intraocular pressure control: does it protect the visual field? In: KrieglsteinG.K., ed. Glaucoma update IV.Berlin: Springer Verlag1991; 179–86.
5.
AbedinS., SimmonsR.J., GrantW.M.Progressive low tension glaucoma. Treatment to stop glaucomatous cupping and visual field loss when these progress despite normal IOP.Ophthalmology1982; 89: 1–6.
6.
KolkerA.E.Visual prognosis in advanced glaucoma: a comparison of medical and surgical therapy for retention of vision in 101 eyes with advanced glaucoma.Trans Am Ophthalmol Soc1977; 75: 539–55.
PalmbergP.F.Glaucoma surgery with mitomycin: a review.Chibret Int J Ophthalmol1994; 10: 16–21.
9.
HitchingsR.A.The best option for POAG: medicine or surgery.Chibret Int J Ophthalmol1994; 10: 86–91.
10.
PapovicV., SjostrandJ.Long-term outcome following trabeculectomy.Acta Ophthalmol1991; 69: 299–304.
11.
MigdalC., GregoryW., HitchingsR.A.Long-term functional outcome after early surgery compared with laser and medicine in open angle glaucoma.Ophthalmology1994; 101: 1651–7.
12.
WernerE.B., DranceS.M., SchulzerM.Trabeculectomy and the progression of glaucomatous visual field loss.Arch Ophthalmol1977; 95: 1374–7.
13.
DakeC.L., GreveE.L.Four-year follow-up of glaucoma operation.Int Ophthalmol1979; 1: 139–45.
14.
CostaV.P.Primary trabeculectomy in young adults.Ophthalmology1993; 100: 1071–6.
15.
MigdalC., HitchingsR.A.Control of chronic simple glaucoma with primary medical, surgical and laser treatment.Trans Ophthalmol Soc UK1986; 105: 653–6.
16.
JayI.L., MurrayS.B.Early trabeculectomy vs. conventional management in primary open-angle glaucoma.Br J Ophthalmol1988; 72: 881–9.
17.
WatsonP.G., JakemanC., OzturkM.. The complications of trabeculectomy (a 20 years follow-up).Eye1990; 4: 425–38.
18.
SturmerJ., BroadwayD.C., HitchingsR.A.Young patient trabeculectomy. Assessment of risk factors for failure.Ophthalmology1993; 100: 928–39.
19.
DavidR., FreedmanT., LuntzA.A comparative study of Watson's and Cairn's trabeculectomies in a black population with open angle glaucoma.Br J Ophthalmol1977; 61: 117–9.
20.
D'ErmoF., BonomiL., DoroD.A critical analysis of the long-term results of trabeculectomy.Am J Ophthalmol1979; 88: 829–35.
21.
InabaA.Long-term results of trabeculectomy in the Japanese: an analysis by the life-table method.Jpn J Ophthalmol1982; 26: 361–72.
22.
WatsonP.G., GriersonI.The place of trabeculectomy in the treatment of glaucoma.Ophthalmology1981; 88: 175–96.
RollinsD.F., DranceS.M.Five-year follow-up of trabeculectomy in the management of chronic angle glaucoma. In: “Symposium on glaucoma”. Trans of the New Orleans Academy of Ophthalmology.St Louis: CV Mosby1981; 295–307.
ParrishR.K.II, FolbergR.Wound healing in glaucoma surgery. In: RitchR., ShieldsM.B., KrupinT., eds. The glaucomas. St.Louis: CV Mosby1989; 633–43.
31.
KhawP.T., DoyleJ.W., SherwoodM.P.. Effect of intraoperative 5FU or mitomycin C on glaucoma filtration surgery in the rabbit.Ophthalmology1993; 100: 367–72.
32.
TaheryM.D., LeeD.A.Review: pharmacologic control wound healing in glaucoma filtering surgery.J Ocul Pharmacol1989; 5: 155–79.
33.
ParrishR.K.II. Antiproliferative surgery: intraoperative mitomycin C versus postoperative 5-fluorouracil.Chibret Int J Ophthalmol1994; 10/3: 76–85.
34.
HeuerD.K., ParrishR.K.II, GresselM.G.. 5-fluorouracil and glaucoma findings surgery. II - A pilot study.Ophthalmology1984; 91: 384–94.
35.
KerstenH.Mechanisms of action of mitomycins. In: Antineoplastic and immunosuppressive agents; pt. II. In: SartorelliA.C., JohnsD.G., eds. Handbuch der Experimentellen Pharmakologic. Vol 38 - Berlin: Springer Verlag1975; 47–64.
36.
YamamotoT., VaraniJ., SoongH.. Effects of 5FU and mitomycin C on cultured rabbit subconjunctival fibroblasts.Ophthalmology1990; 97: 1204–10.
37.
ChenC.W.Enhanced intraocular pressure controlling effectiveness of trabeculectomy by local application of Mitomycin C.Trans Asia-Pacific Acad Ophthalmol1983; 9: 172–7.
38.
KitazawaY.Low-dose and high-dose mitomycin trabeculectomy as an initial surgery in primary open angle glaucoma.Ophthalmology1993; 100: 1624–8.
39.
PalmerS.S.Mitomycin as an adjunct chemotherapy with trabeculectomy.Ophthalmology1991; 98: 317–21.
40.
YamamotoT., Suemori-MatsushitaH., IchianM.. Glaucoma filtering surgery and mitomycin C.Chibret Int J Ophthalmol1994; 10/3: 92–6.
41.
SkutaG.L.Intraoperative mitomycin versus postoperative 5 fluorouracil in high-risk glaucoma filtering surgery.Ophthalmology1992; 99: 438–44.
42.
KitazawaY.Trabeculectomy with mitomycin: a comparative study with fluorouracil.Arch Ophthalmol1991; 109: 1693–8.
43.
LampingK.A., BelkinJ.K.5-fluorouracil and mitomycin C in pseudophakic patients.Ophthalmology1995; 102: 70–5.
44.
MartiniE., LaffiG.L., ScorolliL., MeduriR.Gli antimetaboliti nella chirurgia filtrante del glaucoma: vantaggi, complicazioni, indicazioni.Bollettino di Oculistica1996; 75(Suppl 2): S235–S248.
45.
KitazawaY., YamamotoT.The risk profile of mitomycin C in glaucoma surgery.Curr Opin Ophthalmol1994; 5: 105–9.
46.
StamperR.L., McMenemyM.C., LiebermanM.F.Hypotonus maculopathy after trabeculectomy with subconjunctival 5-fluorouracil.Am J Ophthalmol1992; 114: 544–53.
47.
JampelH.D., PasqualeJ.R., DibernardoC.Hypotony maculopathy following trabeculectomy with mitomycin C.Arch Ophthalmol1992; 110: 1049–50.
48.
YaldoM.K., StamperR.L.Long-term effects of Mitomycin on filtering blebs: lack of fibrovascular proliferative response following severe inflammation.Arch Ophthalmol1993; 111: 824–6.
49.
SchwartzA.L., WeissH.S.Bleb leak with hypotony after laser suture lysis and trabeculectomy with mitomicyn C.Arch Ophthalmol1992; 110: 1046–9.
