SpringerLink
Log in

Two-stage intra-tenon injection versus sponge-applied mitomycin C-augmented trabeculectomy: a one-year study

  • Original Paper
  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

Mitomycin C (MMC) is normally used to avoid scar formation in trabeculectomy. There has been a shift from conventional delivery via soaked sponges to preoperative injection of MMC. This study aimed to compare the effectiveness of a modified two-stage low-dose intra-Tenon injection with soaked sponges of MMC for trabeculectomy over a 1-year follow-up period.

Methods

This retrospective study enrolled patients with glaucoma undergoing modified trabeculectomy with a two-stage intra-Tenon injection (0.01%, 0.1 mL) or soaked sponges (0.02%) of MMC. In the former group, patients received intra-Tenon injection of MMC (the first stage) at least 4 h before trabeculectomy (the second stage). Patient characteristics, preoperative and postoperative intraocular pressure, antiglaucoma medication use, complications, and post-trabeculectomy surgical interventions were recorded during a 1-year follow-up period.

Results

There were 36 and 35 eyes in the injection and sponge groups, respectively, in 58 patients. The injection group showed significantly lower intraocular pressure (p < 0.05) at every time point except on postoperative day 1 and week 1, fewer medications at the 1-year follow-up (p = 0.018), and a higher complete success rate (p = 0.011) than the sponge group. Both techniques showed a significant reduction in intraocular pressure and medication use at the 1-year follow-up. There were no significant differences in complications between both groups.

Conclusion

Our two-stage intra-Tenon MMC injection technique resulted in lower postoperative intraocular pressure, less antiglaucoma medication use, and fewer needling revisions compared to the sponge technique.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Cairns JE (1968) Trabeculectomy. preliminary report of a new method. Am J Ophthalmol 66:673–679

    Article  CAS  PubMed  Google Scholar 

  2. Do JL, Xu BY, Wong B, Camp A, Ngai P, Long C, Proudfoot J, Moghimi S, Yan D, Welsbie DS, Weinreb RN (2020) A randomized controlled trial comparing subconjunctival injection to direct scleral application of mitomycin C in trabeculectomy. Am J Ophthalmol 220:45–52. https://doi.org/10.1016/j.ajo.2020.07.002

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Wilkins, M., A. Indar, and R. Wormald (2005) Intra-operative mitomycin C for glaucoma surgery. Cochrane Database Syst Rev. CD002897. doi: https://doi.org/10.1002/14651858.CD002897.pub2

  4. Lama PJ, Fechtner RD (2003) Antifibrotics and wound healing in glaucoma surgery. Surv Ophthalmol 48:314–346. https://doi.org/10.1016/s0039-6257(03)00038-9

    Article  PubMed  Google Scholar 

  5. Chen CW, Huang HT, Bair JS, Lee CC (1990) Trabeculectomy with simultaneous topical application of mitomycin-C in refractory glaucoma. J Ocul Pharmacol 6:175–182. https://doi.org/10.1089/jop.1990.6.175

    Article  PubMed  Google Scholar 

  6. Sisto D, Vetrugno M, Trabucco T, Cantatore F, Ruggeri G, Sborgia C (2007) The role of antimetabolites in filtration surgery for neovascular glaucoma: intermediate-term follow-up. Acta Ophthalmol Scand 85:267–271. https://doi.org/10.1111/j.1600-0420.2006.00810.x

    Article  CAS  PubMed  Google Scholar 

  7. Palmer SS (1991) Mitomycin as adjunct chemotherapy with trabeculectomy. Ophthalmology 98:317–321. https://doi.org/10.1016/s0161-6420(91)32293-0

    Article  CAS  PubMed  Google Scholar 

  8. Maheshwari D, Kanduri S, Rengappa R, Kadar MA (2020) Intraoperative injection versus sponge-applied mitomycin C during trabeculectomy: one-year study. Indian J Ophthalmol 68:615–619. https://doi.org/10.4103/ijo.IJO_963_19

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lim MC, Hom B, Watnik MR, Brandt JD, Altman AR, Paul T, Tong MG (2020) A comparison of trabeculectomy surgery outcomes with mitomycin-C applied by intra-tenon injection versus sponge. Am J Ophthalmol 216:243–256. https://doi.org/10.1016/j.ajo.2020.03.002

    Article  CAS  PubMed  Google Scholar 

  10. Huang ASKG (2017) Intraoperative injection vs sponge-applied mitomycin C during trabeculectomy: one-year study. J Curr Glaucoma Pract 11:101–106. https://doi.org/10.5005/jp-journals-10028-1233

    Article  PubMed  PubMed Central  Google Scholar 

  11. Guimaraes ME, de Padua Soares B, de Bezerra F, Miranda Cordeiro CH, Carvalho DN, Danif TS, Prata SKD, Kanadani FN (2019) Glaucoma surgery with soaked sponges with mitomycin C vs sub-tenon injection: short-term outcomes. J Curr Glaucoma Pract 13:50–54. https://doi.org/10.5005/jp-journals-10078-1254

    Article  PubMed  PubMed Central  Google Scholar 

  12. Esfandiari H, Pakravan M, Yazdani S, Doozandeh A, Yaseri M, Conner IP (2018) Treatment outcomes of mitomycin C-augmented trabeculectomy, sub-tenon injection versus soaked sponges, after 3 years of follow-up: a randomized clinical trial. Ophthalmol Glaucoma 1:66–74. https://doi.org/10.1016/j.ogla.2018.06.003

    Article  PubMed  Google Scholar 

  13. Kandarakis SA, Papakonstantinou E, Petrou P, Diagourtas A, Ifantides C, Georgalas I, Serle J (2021) 1 year randomized comparison of safety and efficacy of trabeculectomy with MMC subtenon injection versus MMC infused sponges. Ophthalmol Glaucoma. https://doi.org/10.1016/j.ogla.2021.05.006

    Article  PubMed  Google Scholar 

  14. Pakravan M, Esfandiari H, Yazdani S, Douzandeh A, Amouhashemi N, Yaseri M, Pakravan P (2017) Mitomycin C-augmented trabeculectomy: subtenon injection versus soaked sponges: a randomised clinical trial. Br J Ophthalmol 101:1275–1280. https://doi.org/10.1136/bjophthalmol-2016-309671

    Article  PubMed  Google Scholar 

  15. Quist MS, Brown N, Bicket AK, Herndon LW (2018) The short-term effect of subtenon sponge application versus subtenon irrigation of mitomycin-C on the outcomes of trabeculectomy with Ex-PRESS glaucoma filtration device: a randomized trial. J Glaucoma 27:148–156. https://doi.org/10.1097/IJG.0000000000000830

    Article  PubMed  Google Scholar 

  16. Kandarakis SA, Papakonstantinou E, Petrou P, Diagourtas A, Ifantides C, Georgalas I, Serle J (2022) One-year randomized comparison of safety and efficacy of trabeculectomy with mitomycin C sub-tenon injection versus mitomycin C-infused sponges. Ophthalmol Glaucoma 5:77–84. https://doi.org/10.1016/j.ogla.2021.05.006

    Article  PubMed  Google Scholar 

  17. Kumar CM, Eid H, Dodds C (2011) Sub-Tenon’s anaesthesia: complications and their prevention. Eye (Lond) 25:694–703. https://doi.org/10.1038/eye.2011.69

    Article  CAS  PubMed  Google Scholar 

  18. Krix-Jachym K, Żarnowski T, Rękas M (2017) Risk factors of malignant glaucoma occurrence after glaucoma surgery. J Ophthalmol 2017:9616738. https://doi.org/10.1155/2017/9616738

    Article  PubMed  PubMed Central  Google Scholar 

  19. Lee E, Doyle E, Jenkins C (2008) Trabeculectomy surgery augmented with intra-Tenon injection of mitomycin C. Acta Ophthalmol 86:866–870. https://doi.org/10.1111/j.1755-3768.2007.01147.x

    Article  PubMed  Google Scholar 

  20. Mehel E, Weber M, Stork L, Péchereau A (1998) A novel method for controlling the quantity of mitomycin-C applied during filtering surgery for glaucoma. J Ocul Pharmacol Ther 14:491–496. https://doi.org/10.1089/jop.1998.14.491

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

None declared.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1St Road, Zuoying District, Kaohsiung City, 81362, Taiwan

    En-Jie Shih & Ying-Ying Chen

  2. School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan

    En-Jie Shih & Ying-Ying Chen

  3. Shu-Zen Junior College of Medicine and Management, Kaohsiung City, Taiwan

    Ying-Ying Chen

Authors
  1. En-Jie Shih
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ying-Ying Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

YYC contributed to the concept and study design. EJS and YYC had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. EJS collected the data, participated in data analysis, and drafted the manuscript. YYC critically reviewed the manuscript for important intellectual content. Both authors read and approved the final manuscript.

Corresponding author

Correspondence to Ying-Ying Chen.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

The Institutional Review Board of Kaohsiung Veterans General Hospital approved the study (KSVGH21-CT5-25). After being approved by the Institutional Review Board in our hospital, we were able to access the clinical/personal patient data used in our research. The tenets of the Declaration of Helsinki were followed.

Consent to participate

The need for the informed consent was waived because of anonymized data and the retrospective nature of the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shih, EJ., Chen, YY. Two-stage intra-tenon injection versus sponge-applied mitomycin C-augmented trabeculectomy: a one-year study. Int Ophthalmol 43, 2593–2603 (2023). https://doi.org/10.1007/s10792-023-02658-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-023-02658-6

Keywords

Search

Navigation