Trabeculectomy With Extended Application Of Mitomycin C In Chronic Open Angle Glaucoma

The purpose of the study was to analyze the effect of extended application of Mitomycin C on intraocular pressure in chronic open angle glaucoma. The patients were diagnosed open angle glaucoma and were on three or more than three topical antiglaucoma medication for at least two years. 0.02 % of freshly prepared MMC was applied for three minute subtenon area and was not washed for further two minutes. The hypothesis is that it is actively absorbed in the first 3 minutes and passive absorption for next two minutes. The complications were also noted due to this extended application of MMC

The study was conducted at Aadil hospital DHA Lahore and Avicenna Medical College and Hospital Lahore from July 2021 to December 2022.

 42 eyes were operated by this extended application of MMC. 20  eyes of 10 patients and 22 eyes of 22 patients were included in the study. IOP was in the range 0f 18-32 mmof Hg with an average of 24. All patients were on three or more topical medications. Follow-up was 10 months. 0.02% MMC was applied under the tenon area after outlining the superficial sclera. After 3 minutes the soaked merocel were removed but the surface was not washed for further 2 minutes making a total of 5 minutes. After wash with BSS , trabeculectomy was performed. The follow up was on day one post-op , week one , monthe one and then two months for next 10 months. IOP and complications were recorded. 

 Post-operative IOP was in the range of 10-14 mm of Hg.  In 39 eyes no topical antiglaucoma medication was required. One topical drop was needed to control the IOP. Bleb was well formed , avascular, and with moderate elaevation. Regarding the complications , only two eyes were having hypotony in first two weeks which settled after without any intervention. No bleb thinning, blebitis or infection were noted in the post-op period

This new technique of extended application of MMC in trabeculectomy proved to be promising. The control of IOP was great with almost no post-op antiglaucoma medications. The eye were free of adverse effect of the medications. Bleb morphology was avascular and moderately elevated. No complications regarding the bleb like thinning or blebitis were noted. This 3+2 minutes application of MMC in trabeculectomy in chronic open angle glaucoma patients showed excellent results