Intra-operative Mitomycin C for glaucoma surgery (Cochrane Review)
Mitomycin C reduces risk of surgery failure for glaucoma but may increase risk of cataracts Glaucoma is a serious condition caused by abnormal pressure on the eye leading to blindness. Surgery is performed to create a channel through the sclera (outer layer of the eyeball) for the fluid in the eye to drain. Sometimes scar tissue blocks this channel, pressure in the eye rises and the operation fails. Mitomycin C is a drug used during the initial stages of surgery to prevent the conjunctiva healing onto the sclera. The review of trials found Mitomycin C reduces the risk of surgery failure but adverse effects include an increased risk of cataracts.
Figures in this publication
Available from: Ilias Georgalas
- "Adjunctive antimetabolites, such as 5-fluorouracil (5-FU) and mitomycin C (MMC), both intra-and postoperatively, are commonly used to enhance the long-term success of trabeculectomy     . However, due to their nonselective cytotoxicity, which could lead to conjunctival barrier breakdown , their use is not free of increased risk of complications, some of them devastating, such as ischemic and leaking bleb which could predispose to serious infections and even endophthalmitis     . "
[Show abstract] [Hide abstract]
ABSTRACT: Purpose. To compare the outcomes of trabeculectomy with and without Healaflow (Anteis S.A, Geneva, Switzerland), a high molecular weight viscoelastic gel, in patients requiring glaucoma surgery. Methods. This was a retrospective, comparative, interventional case-control study. Forty patients formed two matched study groups and were analyzed (trabeculectomy alone (control) versus trabeculectomy with Healaflow (study)). Results. The postoperative levels of mean IOP were statistically significantly lower than preoperatively in both groups, for all time intervals. There was no statistical difference, at the end of the follow-up period, between the two groups in the mean values of the IOP (14.9 ± 3.2 mmHg for the study group versus 14.8 ± 3.3 mmHg for the control group). The number of antiglaucoma drugs used in the study group was reduced from a preoperative mean of 3.4 ± 0.75 to a 6-month postoperative mean of 0.6 ± 0.8 and in the control group from 3.6 ± 0.59 to 0.55 ± 0.9 . Conclusions. Although trabeculectomy with Healaflow appears to be a safe procedure, we failed to identify any significant advantages in the use of Healaflow when compared with trabeculectomy alone, at the end of the 6-month follow-up period.
Available from: Zhichao Yan
- "Despite numerous anti-metabolites medications (e.g., Mitomycin C [MMC] and 5-Fluorouracil [5-FU]) greatly increased the success rate of glaucoma surgeries. However, these drugs may lead to increased incidences of complications, such as persistent postoperative hypotony, corneal problems, filtering bleb leakage, etc [3-6]. Therefore, developing a low toxicity, safe, effective and long lasting medication for anti-proliferation after filtration surgery has long been an important area of research for glaucoma. "
[Show abstract] [Hide abstract]
ABSTRACT: To investigate the efficacy, safety, and mechanisms of Sirolimus sustained delivery film on prevention of scar formation in a rabbit model of glaucoma filtration surgery.
Sixty-four New Zealand white rabbits who underwent trabeculectomy in the right eye were randomly allocated to one of the four treatment regimens: Sirolimus sustained delivery film treatment group (Group A), or drug-free film treatment group (Group B), or 30 ng/ml Sirolimus-soaked sponge treatment group (Group C), or no adjunctive treatment group (Group D), and each group consists of 16 rabbits. Intraocular pressure (IOP), morphologic changes of bleb, anterior chamber flare, and corneal endothelial cell count and complications were evaluated over a 28-day period follow-up time. Aqueous humor samples were gathered from Group A, and the concentration of Sirolimus was measured regularly post-operation. Rabbits were sacrificed on the 7th, 14th, and 28th day post-operation separately, and the fibroblast hypertrophy, infiltration of inflammatory, and proliferation of new collagen fiber formation in each group were evaluated with HE and Masson staining. Proliferative cell nuclear antigen (PCNA) and fibroblast apoptosis were evaluated by immunohistochemistry and terminal deoxynucleotidyl transferasemediated dUTP nick end labeling (TUNEL) assay at the 28th day post-operation.
Both Sirolimus sustained delivery film (Group A) and Sirolimus alone (Group C) were well tolerated in this model, and significantly prolonged bleb survival compared with no drug treatment group (Group B and D; p<0.001). Group A had the longest bleb survival time in comparison with other groups (p<0.001). There were significant differences in IOP readings between Group A and other groups at the last follow-up (p<0.05). The concentration of Group A maintained stable for over 2 weeks, drops from (10.56 ±0.05) ng/ml at day 3 to (7.74 ±0.05) ng/ml at day 14. The number of corneal endothelial cells of Group A was not statistically significant between pre and post-operation. Histologic examination demonstrated that eyes treated with Sirolimus, especially the Sirolimus sustained delivery film, showed an obvious reduction in subconjunctival fibroblast scar tissue formation compared with no drug treatment groups, and had minimal evidence of inflammatory cell infiltration and new collagen deposition in the subconjunctiva. Immunohistochemistry assay showed that PCNA-expression was lower in the Group A (16.25±3.24%) compared to other groups (p<0.01). TUNEL assay showed a significant increase in the number of apoptotic fibroblasts around the surgical area in Group A and Group C (9.75±1.71% and 8.50±1.92%) compared to the Group B and D (p<0.01).
Sirolimus drug sustained delivery film can inhibit inflammatory cell activity, impede fibroblast proliferation activity, and induce fibroblast apoptosis in the filtration surgery sites in rabbit. The results indicate a safe and effective treatment strategy in anti-scaring treatment in glaucoma surgery.
Available from: PubMed Central
- "Mitomycin C is an antiproliferative drug used during the initial stages of glaucoma surgery to prevent the conjunctiva healing onto the sclera. A previous systematic review suggested that the intraoperative MMC application can reduce the failure risk of conventional trabeculectomy . In the present meta-analysis, the IOP-lowering effect of DS with MMC was greater than that of primary DS, with 52.1% of cases achieving target IOP at 4 years. "
[Show abstract] [Hide abstract]
ABSTRACT: To evaluate the intraocular pressure (IOP)-lowering effects achieved by nonpenetrating glaucoma surgery (NPGS) and its modifications in patients with open angle glaucoma.
Randomized controlled trials evaluating patients with primary and secondary open angle glaucoma treated with NPGS were identified through systematic searches. The main outcome measures were the percentage IOP reduction and the complete success rate. Complete success was defined as target endpoint IOP (usually less than 21 mm Hg) without medications. The pooled estimates were calculated using the random effects model.
Both deep sclerectomy (DS) and viscocanalostomy (VCO) were less effective than trabeculectomy (TE) in lowering IOP, with the percentage IOP reductions at 2 years being 35.2% for DS, 30.2% for VCO, and 45.6% for TE. Intraoperative use of implants and mitomycin C (MMC) increased IOP-lowering effects of DS, with IOP reductions at 2 years of 41.1% and 41.7%, respectively. The complete success rates at 4 years were 35.4% for DS, and 22.7% for VCO, lower than that of TE (47.6%). The complete success rates of DS with implants and MMC of 64.6% and 52.1%, respectively, at 4 years, were greater than that of primary DS. NPGS caused major complications in fewer patients than did TE.
Primary deep sclerectomy and primary viscocanalostomy, which can significantly lower IOP, were associated with fewer complications than was TE. However, the IOP-lowering effects of both NPGS seem to be lower than that of primary TE. The efficacy of DS can be improved with the intraoperative use of implants and MMC.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.