Comparison of efficacy and safety of postoperative topical low concentration Mitomycin–C versus higher concentration per-operative on flap Mitomycin–C in Trabeculectomy

Muhammad Tariq Khan, Vitreoretinal Consultant

LRBT Hospital, Lahore Pakistan

Objective
To compare the efficacy and safety of post-operative, low concentration topical Mitomycin-C (MMC) versus conventional Intra-operative higher concentration Mitomycin-C in trabeculectomy
Study Design
Quasi-Experimental
Place and Duration
Layton Rahmatullah Benevolent Trust Hospital (LRBT), Lahore, Pakistan.
May 15, 2008 to Nov 20, 2009

Patients and methods
Seventy eyes of 70 patients were divided randomly into groups 1 & 2 of 35 eyes each. Group 1 received topical 3 minute application of Mitomycin-C (0.1 ml of 0.05mg/ml) for three consecutive days, post-operative using a 5x5mm microsponge. Group 2 received per-operative episcleral 3 minute application of Mitomycin-C (0.1 ml of 0.2mg/ml) using 5x5mm microsponge. The patients were followed for 1 year to see if the intraocular pressure (IOP) stays equal to or below 21 mmHg without medication. Any complication that occurred during this period was made note of.

Results
No statistical difference in surgical success rate was found between Group 1 and 2. After 1 year, Group 1 had a 97%, whereas Group 2 had 85.7% success rates respectively. Serious complications were low among both groups. In Group 1, one eye developed corneal epithelial defects. In Group 2 one eye developed endophthalmitis and another hypotony related maculopathy.

Conclusion
Topical Mitomycin-C applied post-operatively for 3 consecutive days in lower concentrations is safe and at least as efficacious as Intra-operative higher concentration MMC in lowering IOP.

Key words
Glaucoma, Intra-ocular pressure, Trabeculectomy, Antimetabolites, Mitomycin-C