Evaluation of intraoperative use of mitomycin C in subscleral trabeculectomy surgery

Objective The aim of the study was to evaluate the effectiveness and complications of mitomycin C (MMC) use in subscleral trabeculectomy surgery. Background MMC is an antimetabolite agent used to limit the scarring process, which is the main cause of failure of subscleral trabeculectomy surgery. However, it may increase the incidence of adverse effects. Patients and methods A prospective interventional study involving 35 eyes of 28 patients having glaucoma was conducted. All of them underwent subscleral trabeculectomy with adjuvant intraoperative use of MMC (0.2 mg/ml) for 2 min, and were followed up for at least 9 months recording intraocular pressure (IOP) testing, best corrected visual acuity, Seidel testing, bleb grading according to the Indiana bleb appearance grading scale, and complications if present. Results The mean IOP decreased from 32.03 mmHg preoperatively to 13.83 mmHg at 9 months postoperatively. The mean IOP drop registered was 56.82%. Overall, 29 (82.9%) eyes ended with complete success, three (8.6%) eyes ended with qualified success, and three (8.6%) eyes failed. The incidence of complications was 51.5%, and most of them were transient and self-limited conditions. Further management, including both medications and minor procedures, improved the postoperative outcomes. Conclusion MMC of 0.2 mg/ml used for 2 min intraoperatively is an effective adjunctive treatment in patients with glaucoma; however, with this dose, it is associated with some complications. So it is a double-edged weapon that should be used wisely, only when indicated, with optimum concentration and duration.