Trabeculectomy is the most common incisional surgery for glaucoma. In the early years, the post-trabeculectomy failure rate was up to 20%-90%. However, with the introduction of antimetabolites such as 5-fluorouracil (5-FU) and mitomycin C (MMC), which act by inhibiting scar formation and tissue remodeling, surgical success rates have substantially improved. Previous meta-analysis comparing 5-FU and MMC demonstrated that MMC was associated with better clinical outcomes, including lower mean IOP and higher rates of complete and qualified success.
Traditionally, MMC has been applied using sponges. However, there has been a trend in recent years towards intraoperative injection.
Some advantages of injection are no risk of accidental retention, which can lead to infection or necrosis, reduction in surgical time, and accuracy of the injected dose.
A systematic review and meta-analysis was performed to compare the efficacy and safety of intraoperative injection of mitomycin C (MMC) versus conventional MMC-soaked sponges in patients undergoing trabeculectomy. Pubmed, Cochrane, and Embase were searched for studies published until December 2023 comparing injection and sponge techniques during trabeculectomy.
The pooled analyses of 11 studies revealed that the incidence of complete surgical success was higher in the injection group (OR=1.79; 95% CI: 1.33–2.40; complete success). In 10 trials, the rate of qualified success was found to be greater in the sponge group (OR=0.61; 95% CI: 0.42–0.89; qualified success). In addition, 8 trials demonstrated no significant difference between groups in the incidence of treatment failure (OR=0.87; 95% CI: 0.60–1.26; treatment failure).
The dose of MMC varied from 0.1 to 0.4 mg/mL.
The main findings in the overall analyzed population were: (1) lower mean IOP at 6 months in the injection group; (2) no significant difference between groups in mean IOP at 12 months; (3) no significant difference between groups in the number of antiglaucoma medications at 6 months and ≥12 months; (4) higher rate of complete success in the injection group; and (5) no significant difference between the groups in the incidence of postoperative complications.
The study concluded that, intraoperative MMC injection had a greater rate of complete surgical success and reduction in the number of medications. However, there was no significant difference in mean IOP at 12 months between groups. MMC injection was as safe as sponge application in trabeculectomy.
REFERENCE:
Gaban, Natália MD*; Pelison, Gustavo MD*; Binotti, William W. MD†; Taranta, Luiz F. MD*; Krishnan, Chandrasekharan MD†. Intraoperative Injection Versus Sponge-Applied Mitomycin C During Trabeculectomy In Glaucoma: A Systematic Review and Meta-Analysis. Journal of Glaucoma 34(12):p 1003-1016, December 2025. | DOI: 10.1097/IJG.0000000000002624
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