Simultaneous subconjunctival and subscleral mitomycin-C application in trabeculectomy.

OBJECTIVE

To establish the efficacy and safety of simultaneous subconjunctival and subscleral application of mitomycin-C in trabeculectomy.

DESIGN

A prospective, randomized study.

PARTICIPANTS

Sixty-eight patients (68 eyes) with refractory glaucomas were included in the study.

INTERVENTION

Eyes were randomly assigned to receive intraoperative mitomycin-C (0.3 mg/ml) applied under the conjunctival flap (group 1), scleral flap (group 2), or under both flaps (group 3).

MAIN OUTCOME MEASURES

Mean intraocular pressure (IOP), postoperative medications, visual acuity, filtering bleb appearance, and complications.

RESULTS

There was a significant difference in IOP at 6, 9, and 12 months after surgery among the three groups (P = 0.021, 0.026, and 0.033, respectively ANOVA). At 12 months, the mean IOP in group 3 was 9.8+/-3.7 mm Hg compared with 13.4+/-5.5 mm Hg in group 2. (P = 0.015) and 12.4+/-4.4 mm Hg in group 1 (P = 0.039). Success rate (21 mm Hg or less), number of antiglaucoma medications, and complications showed no statistical significant difference between the three groups at each postoperative visit.

CONCLUSIONS

Mitomycin-C applied under the scleral flap may have an additional beneficial effect when combined with simultaneous subconjunctival exposure.