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

Main Article Content

Sutee Ananprasert
Naruechanok Lertkusol
Luksamon Pas-arj

Abstract

Objectives: To compare the efficacy and safety of mitomycin-C (MMC) injected intratenon with conventional soaked-sponge-application 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-application. Postoperative intraocular pressure (IOP) level was the primary outcome measure, with survival rates for IOP control, number of glaucoma medications used, complication rates, and vision serving as secondary outcomes.
Results: There were 90 eyes 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). The time to failure for postoperative IOP control was significantly different between groups. There was a higher 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.

Article Details

Section
Original Study

References

Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology. 2014;121(11):2081-90.

Jinza K, Saika S, Kin K, Ohnishi Y. Relationship between formation of a filtering bleb and an intrascleral aqueous drainage route after trabeculectomy: evaluation using ultrasound biomicroscopy. Ophthalmic Res. 2000;32(5):240-3.

Hata T, Hoshi T, Kanamori K, Matsumae A, Sano Y, Shima T, et al. Mitomycin, a new antibiotic from Streptomyces. I. J Antibiot (Tokyo). 1956;9(4):141-6.

Vinod K, Gedde SJ, Feuer WJ, Panarelli JF, Chang TC, Chen PP, et al. Practice Preferences for Glaucoma Surgery: A Survey of the American Glaucoma Society. J Glaucoma. 2017;26(8):687-93.

Drolsum L, Willoch C, Nicolaissen B. Use of amniotic membrane as an adjuvant in refractory glaucoma. Acta Ophthalmol Scand. 2006;84(6):786-9.

Robin AL, Ramakrishnan R, Krishnadas R, Smith SD, Katz JD, Selvaraj S, et al. A long-term dose-response study of mitomycin in glaucoma filtration surgery. Arch Ophthalmol. 1997;115(8):969-74.

Yamamoto T, Sawada A, Mayama C, Araie M, Ohkubo S, Sugiyama K, et al. The 5-year incidence of bleb-related infection and its risk factors after filtering surgeries with adjunctive mitomycin C: collaborative bleb-related infection incidence and treatment study 2. Ophthalmology. 2014;121(5):1001-6.

Soltau JB, Rothman RF, Budenz DL, Greenfield DS, Feuer W, Liebmann JM, et al. Risk factors for glaucoma filtering bleb infections. Arch Ophthalmol. 2000;118(3):338-42.

Lee E, Doyle E, Jenkins C. Trabeculectomy surgery augmented with intra-Tenon injection of mitomycin C. Acta Ophthalmol. 2008;86(8):866-70.

Pakravan M, Esfandiari H, Yazdani S, Douzandeh A, Amouhashemi N, Yaseri M, et al. Mitomycin C-augmented trabeculectomy: subtenon injection versus soaked sponges: a randomised clinical trial. Br J Ophthalmol. 2017;101(9):1275-80.

Esfandiari H, Pakravan M, Yazdani S, Doozandeh A, Yaseri M, Conner IP. Treatment Outcomes of Mitomycin C-Augmented Trabeculectomy, Sub-Tenon Injection versus Soaked Sponges, after 3 Years of Follow-up: A Randomized Clinical Trial. Ophthalmol Glaucoma. 2018;1(1):66-74.

Albert SK, Huang G, Linda YH. Intraoperative Injection vs Sponge-applied Mitomycin C during Trabeculectomy: One-year Study. J Curr Glaucoma Pract. 2017;11(3):101-6.

Lim MC, Hom B, Watnik MR, Brandt JD, Altman AR, Paul T, et al. A Comparison of Trabeculectomy Surgery Outcomes With Mitomycin-C Applied by Intra-Tenon Injection Versus Sponge. Am J Ophthalmol. 2020;216:243-56.