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. 1998 Apr;82(4):397–403. doi: 10.1136/bjo.82.4.397

Trabeculectomy augmented with mitomycin C application under the scleral flap

S Beatty 1, T Potamitis 1, S Kheterpal 1, E O'Neill 1
PMCID: PMC1722562  PMID: 9640188

Abstract

AIM—The authors investigated the safety and intraocular pressure (IOP) lowering effectiveness of trabeculectomy augmented with mitomycin C application beneath the scleral flap, and assessed the influence of preoperative risk factors on the surgical outcome.
METHODS—A retrospective study of 72 consecutive high risk eyes undergoing trabeculectomy with adjunctive mitomycin C (0.2 mg/ml) applied under the scleral flap for 5 minutes was performed. Each eye was ascribed a score based on the number of preoperative risk factors, and categorised into one of three risk factor groups. Success was described as unqualified where IOP was ⩽ 21 mm Hg without medication and qualified where antiglaucomatous therapy was required to maintain it at such a level. A life table analysis of IOP control was calculated.
RESULTS—The mean IOP (SD) fell from a preoperative level of 28.4 (6.9) to a level of 16.63 (8.06) mm Hg at the last follow up (paired Student's t test: p< 0.0001). Fifty two eyes (72%) were classed as unqualified successes. The survival rates did not differ significantly between different risk factor groups (log rank test: χ2 = 0.967, p>0.1). The incidence of postoperative complications compared favourably with reports of mitomycin C application between Tenon's capsule and the undissected scleral bed.
CONCLUSION—The results illustrate that mitomycin C applied beneath the scleral flap during trabeculectomy in high risk eyes is associated with a success rate comparable to other modes of application. The incidence of potentially serious complications such as conjunctival wound leak and prolonged hypotony was lower than previously published data reporting sub-Tenon's administration of mitomycin C. The number and nature of preoperative risk factors do not appear to influence the surgical outcome. A possible mechanism of action is proposed.

 Keywords: glaucoma; intraocular pressure; trabeculectomy; mitomycin C

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Figure 1  .

Figure 1  

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(A) Following the creation of a fornix based conjunctival flap, a partial thickness rectangular scleral flap is dissected. (B) A trimmed, MMC saturated sponge is then placed beneath the scleral flap while taking care that it does not come into contact with the conjunctiva.

Figure 2  .

Figure 2  

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Intraocular pressure effect of trabeculectomy with adjunctive mitomycin C for 72 high risk eyes. Numbers above the line show the fraction of patients receiving antiglaucoma medication.

Figure 3  .

Figure 3  

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Kaplan-Meier cumulative survival plot for trabeculectomies augmented with mitomycin C application beneath the scleral flap.

Figure 4  .

Figure 4  

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Kaplan-Meier cumulative survival plot for mitomycin augmented trabeculectomies according to risk factor category.

Figure 5  .

Figure 5  

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Kaplan-Meier cumulative survival plot for conventional and mitomycin C (MMC) augmented trabeculectomies in paired eyes.

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