A Comparison of Trabeculectomy Outcomes by Intratenon injection Mitomycin-C Versus Soaked- Sponge-Applied Mitomycin-C: One-year follow up

Abstract

Objectives: To compare the efficacy and safety of intratenon injection of mitomycin-C (MMC) with

that of conventional application of soaked-sponge-applied mitomycin C in trabeculectomy.

Materials and methods : We retrospectively reviewed 90 patients with primary and secondary glaucoma diagnoses who received trabeculectomy surgery with MMC in Thammasat university hospital,Thailand from 2018 to 2021. The MMC was administered to the subjects via either an intratenon injection or a soaked-sponge-applied. Postoperative intraocular pressure (IOP) level was the primary outcome measure, with survival rates for IOP control, number of glaucoma medication used, complication rates, and vision serving as secondary outcomes.

Results : The 90 eyes were available for analysis; 36 eyes had MMC delivered via intratenon injection and 54 eyes via soaked-sponge. Mean preoperative IOP in intratenon group was 28.44 ± 12.87 mmHg and soaked sponge-applied group was 26.83 ± 6.51 mmHg, which reduced to 14.72 ± 10.08 and 11.63 ± 3.76 mmHg at final visit with P value of 0.373, respectively. Mean preoperative number of antiglaucoma medications was 3.64 ± 0.54 in intratenon group and 3.70 ± 0.54 in soaked-sponge-applied, which reduced to 0.78 ± 1.07 and 0.30 ± 0.82 with P value of 0.007, respectively. Overall, success rate (complete + qualified) was 80.6% in intratenon injection and 96.3% in soaked-sponge-applied at final visit with P value of 0.030, respectively. There was no difference between groups in postoperative complications including choroidal effusion, over filtration, hypotony, malignant glaucoma, bleb leak and blebitis (p > 0.05). However, there were four patients experienced no light perception vision in intratenon compared with only one patient in

soaked-sponge group. A Time to failure for postoperative IOP control was significantly different between groups. There was higher in survival rate of the soaked-sponge-applied group than intratenon group.

Conclusions : Both MMC delivery methods are effective in reducing IOP and the number of antiglaucoma medications. However, the sponge-applied group demonstrated superior success rates without an increased risk of complications.
Keywords : Trabeculectomy, Intratenon injection mitomycin-C, Soaked-sponge-applied mitomycin- C