Aravind Eye Hospital, Glaucoma Department, Madurai, Tamil Nadu, India.
Indian J Ophthalmol. 2023 Feb;71(2):673-674. doi: 10.4103/ijo.IJO_1889_22.
The introduction of mitomycin C (MMC) as an adjunct to trabeculectomy was a major advance in the ability to improve the Intra ocular pressure lowering efficiency of the procedure. The time tested traditional way of administration of MMC is via a sponges soaked in it, duration and concentration varies depending on risk of failure. A subconjunctival injection of MMC instead of these sponges is recently being used as a promising alternative.
Here is the video demonstrating the 2 possible ways to prepare and apply MMC during a trabeculectomy surgery.
Intraoperative injection of MMC in trabeculectomy has several advantages over conventional method ofsponge application. A large MMC treatment area produces more diffuse and elevated blebs. Large-area MMC application also seems to increase long-term success without increasing the complication rates in trabeculectomies. Direct and diffuse application of MMC by injection may promote less scarring and vascularization of the bleb. To achieve the same surface area of exposure with sponges, i.e.achieved with injection, the surgeon must use multiple sponges, all of which must be carefully collected thereafter. The injection method,therefore,eliminates the risk of retained sponges.
injection of MMC may be as safe and as effective as conventional sponge application of MMC with comparable estimated complete treatment success with relatively lower complication rates.
丝裂霉素 C（MMC）作为小梁切除术的辅助药物的引入，是提高该手术降低眼内压效率的重大进展。经过时间考验的传统 MMC 给药方式是将其浸泡在海绵中，持续时间和浓度取决于失败风险。最近，一种替代方法是将 MMC 直接注射到结膜下，而不是使用这些海绵。
本视频演示了在小梁切除术中准备和应用 MMC 的 2 种可能方法。
与传统的海绵应用方法相比，术中在小梁切除术中注射 MMC 具有几个优势。大面积的 MMC 治疗区域会产生更广泛和更高的滤过泡。大面积 MMC 应用似乎也可以增加长期成功率，而不会增加小梁切除术的并发症发生率。直接和广泛地注射 MMC 可能会促进滤过泡的疤痕和血管化减少。为了用海绵实现相同的暴露表面积，即通过注射实现，外科医生必须使用多个海绵，此后必须仔细收集所有这些海绵。因此，注射方法消除了残留海绵的风险。
与传统的 MMC 海绵应用相比，MMC 注射可能同样安全有效，估计完全治疗成功率相当，但并发症发生率相对较低。
