Mudhol Rekha R, Ray Arkaprava
Ophthalmology, Shri BM Patil Medical College, Bijapur Lingayat District Educational Association (Deemed to be University), Vijayapura, IND.
Cureus. 2024 Jun 10;16(6):e62119. doi: 10.7759/cureus.62119. eCollection 2024 Jun.
Background Trabeculectomy, with the application of mitomycin C (MMC), has been the gold standard glaucoma-filtering surgery. The conventional method of applying MMC using soaked sponges does not ensure a controlled amount of delivery of MMC, and incidences of blebitis are reported to be associated with leftover sponges. This study aims to assess the safety and efficacy of a low dose (0.1 mg/ml) of MMC administered through subtenon injection during trabeculectomy combined with cataract extraction, addressing existing research gaps. Methods It is a prospective interventional study on patients who underwent trabeculectomy with a subtenon injection of 0.1 mg/ml of MMC combined with cataract extraction and were followed up over six months. Efficacy was determined in terms of intraocular pressure (IOP) reduction; bleb architecture was graded using the Indiana Bleb Appearance Grading System (IBAGS) and success rate, and safety was commented upon in terms of complications. Results Thirty patients were enrolled, with the majority having primary open-angle glaucoma (63.33%), while 36.67% had primary angle-closure glaucoma. Baseline IOP was 31.40(±10.38) mmHg. It significantly reduced to 14.60(±3.75) mmHg on the first postoperative day, decreasing to 9.55(±1.57) mmHg by the sixth postoperative month (p=0.001). The percentage reduction in IOP was substantial, 69.57%, by the sixth postoperative visit. Bleb morphology assessment using IBAGS revealed significant improvements in bleb height and extent and a reduction in vascularity over the six-month follow-up (p=0.001), and no eyes had bleb encapsulation. Out of the total patients, 93.33% achieved controlled IOP without anti-glaucoma medications, while 6.67% required one medication for IOP control. Complications were minimal, with transient corneal edema in six patients and manageable postoperative hypotony in one case. Conclusion A subtenon injection of MMC during trabeculectomy effectively reduces IOP and promotes favorable bleb architecture, offering an effective and safer alternative to the conventional approach.
小梁切除术联合丝裂霉素C（MMC）应用一直是青光眼滤过手术的金标准。使用浸泡海绵应用MMC的传统方法不能确保MMC的递送量得到控制，据报道，睑缘炎的发生率与残留海绵有关。本研究旨在评估小梁切除术联合白内障摘除术中通过球周注射给予低剂量（0.1 mg/ml）MMC的安全性和有效性，以填补现有研究空白。方法：这是一项前瞻性干预性研究，对接受小梁切除术并球周注射0.1 mg/ml MMC联合白内障摘除术的患者进行为期六个月的随访。根据眼压（IOP）降低情况确定疗效；使用印第安纳滤泡外观分级系统（IBAGS）对滤泡结构进行分级并评估成功率，根据并发症情况评价安全性。结果：共纳入30例患者，大多数为原发性开角型青光眼（63.33%），而36.67%为原发性闭角型青光眼。基线眼压为31.40（±10.38）mmHg。术后第一天显著降至14.60（±3.75）mmHg，术后第六个月降至9.55（±1.57）mmHg（p = 0.001）。术后第六次随访时眼压降低百分比高达69.57%。使用IBAGS进行的滤泡形态评估显示，在六个月的随访中，滤泡高度和范围有显著改善，血管化程度降低（p = 0.001），且无滤泡包裹情况。在所有患者中，93.33%在未使用抗青光眼药物的情况下眼压得到控制，而6.67%需要一种药物来控制眼压。并发症极少，6例患者出现短暂性角膜水肿，1例患者出现可控制的术后低眼压。结论：小梁切除术中球周注射MMC可有效降低眼压并促进良好的滤泡结构形成，为传统方法提供了一种有效且更安全的替代方案。
