Comparison of Outcomes of Trabeculectomy with Viscoelastic Implant vs. Trabeculectomy with Mitomycin C (MMC)

Raheela Hafiz; Abdul Rauf; Shagufta Parveen; Taimoor Ashraf Khan; Shingrif Shabbir Khan; Atiya Iqbal

doi:10.51253/pafmj.v76iSUPPL-8.13478

Authors

Raheela Hafiz Department of Ophthalmology, Armed Forces Institute of Ophthalmology /National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
Abdul Rauf Department of Ophthalmology, Armed Forces Institute of Ophthalmology /National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
Shagufta Parveen Department of Ophthalmology, Armed Forces Institute of Ophthalmology /National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
Taimoor Ashraf Khan Department of Ophthalmology, Armed Forces Institute of Ophthalmology /National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
Shingrif Shabbir Khan Department of Ophthalmology, Armed Forces Institute of Ophthalmology /National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
Atiya Iqbal Department of Ophthalmology, Armed Forces Institute of Ophthalmology /National University of Medical Sciences (NUMS), Rawalpindi, Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76iSUPPL-8.13478

Keywords:

Glaucoma, Intraocular Pressure, Mitomycin C, Trabeculectomy, Viscoelastic Agents, Wound Healing

Abstract

Objective: To compare trabeculectomy with Mitomycin C (MMC) versus Trabeculectomy with Viscoelastic implant in regards to intraocular pressure (IOP) control, surgical success, and postoperative complications.

Study Design: Quasi-experimental study

Place and Duration of Study: Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi, Pakistan from Apr 2023 to Apr 2024.

Methodology: A total of sixty patients (30 per Group) with Primary Open-Angle Glaucoma (POAG) or Pseudoexfoliation Glaucoma (PXG) fulfilling the inclusion and exclusion criteria were selected. Patients in Group-A underwent trabeculectomy with MMC whereas those in Group-B underwent trabeculectomy with Viscoelastic implant. IOP measurements, bleb morphology, surgical success, and postoperative complications were noted over a 12-month period. Paired and independent t-tests, chi-square tests, and Kaplan-Meier survival analysis were conducted.

Results: At 12 months, mean IOP was comparable between MMC (15.40 ± 2.94 mmHg) and Viscoelastic implant (16.00 ± 3.37 mmHg) (p = 0.600). Complete success was attained in 63.3% of Group-A and 43.3% of Group-B (p = 0.121), while qualified success was 36.7% and 56.7%, respectively (p = 0.100). Postoperative complications were significantly lower in the Group-B (p = 0.001). No significant difference was seen in surgical survival (p = 0.739).

Conclusion: Both adjuncts effectively reduced IOP, but Viscoelastic implant demonstrated a superior safety profile. It may serve as a safer alternative to MMC, though studies with long-term control are needed to confirm sustained efficacy.

Downloads

Download data is not yet available.

References

of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology 2021; 128(5): 712-721. https://doi: 10.1016/j.ophtha.2021.04.009

2. Siddiqui MA, Khan MD, Ahmed A, Raza H, Memon S. Prevalence and risk factors of glaucoma in a tertiary care hospital of Karachi, Pakistan. Pak J Med Sci 2022; 38(5): 1234-1239.

https://doi: 10.12669/pjms.38.5.5433

3. Aktas Z, Korkmaz S, Hasanreisoglu M, Onol M, Hasanreisoglu B. Trabeculectomy with large-area Mitomycin-C application as a first-line treatment in advanced glaucoma: Retrospective review. Int J Ophthalmol 2014; 7(1): 104-109. https://doi.org/10.3980/j.issn.2222-3959.2014.01.19

4. Papaconstantinou D, Diagourtas A, Petrou P, Rouvas A, Vergados A, Koutsandrea C, et al. Trabeculectomy with Healaflow versus trabeculectomy for the treatment of glaucoma: A case-control study. J Ophthalmol 2015; 2015: 836269.

https://doi.org/10.1155/2015/836269

5. Bell K, de Padua-Soares Bezerra B, Mofokeng M, Montesano G, Nongpiur ME, Marti MV, et al. Learning from the past: Mitomycin C use in trabeculectomy and its application in bleb-forming minimally invasive glaucoma surgery. Surv Ophthalmol 2021; 66(1): 109-123.

https://doi.org/10.1016/j.survophthal.2020.05.005

6. Ginger-Eke H, Ogbonnaya C, Odayappan A, Shiweobi J. Toxic anterior segment syndrome following trabeculectomy with mitomycin C. GMS Ophthalmol Cases 2023; 13.

https://doi.org/10.3205/oc000225

7. Maheshwari D, Kanduri S, Rengappa R, Kadar MA. Intraoperative injection versus sponge-applied mitomycin C during trabeculectomy: One-year study. Indian J Ophthalmol 2020; 68(4): 615-619. https://doi.org/10.4103/ijo.IJO_963_19

8. Gulkilik G, Kocabora S, Engin G, Taskapili M, Yilmazli C, Kucuksahin H. Sodium hyaluronate in trabeculectomy: Effect on early complications. Clin Exp Ophthalmol 2006; 34(5): 421-424.

https://doi.org/10.1111/j.1442-9071.2006.01238.x

9. Lopes JF, Moster MR, Wilson RP, Altangerel U, Alvim HS, Tong MG, et al. Subconjunctival sodium hyaluronate 2.3% in trabeculectomy: A prospective randomized clinical trial. Ophthalmology 2006; 113(5): 756-760. https://doi.org/10.1016/j.ophtha.2006.01.040

10. Hung SO. Role of sodium hyaluronate (Healonid) in triangular flap trabeculectomy. Br J Ophthalmol 1985; 69(1): 46-50.

https://doi.org/10.1136/bjo.69.1.46

11. Shalaby HS, Hashem NH. Trabeculectomy with OloGen versus Mitomycin C for the treatment of silicone oil-induced glaucoma. Klin Monbl Augenheilkd 2022; 239(9): 1147-1154.

https://doi.org/10.1055/a-1500-8230

12. Sharma R, Sharma P, Sood S, Sood T. Outcome of trabeculectomy with collagen matrix implant versus mitomycin C in primary glaucoma: A comparative study. Int J Appl Basic Med Res 2021; 11(2): 105-109. https://doi.org/10.4103/ijabmr.IJABMR_21_21

13. Papaconstantinou D, Tzamalis A, Koutsandrea C. The role of HealaFlow in trabeculectomy: early results and comparison with Mitomycin C. Clin Ophthalmol 2020; 14: 1101-1109.

https://doi.org/10.2147/OPTH.S249043

14. Chean CS, Jiang L, Pati Arambage GKN, Ranjit P. Deep sclerectomy-trabeculectomy with mitomycin C in treating glaucoma: Postoperative long-term results. Int J Ophthalmol 2022; 15(12): 1951-1959. https://doi.org/10.18240/ijo.2022.12.09

15. Wu L, Liu J, Chang X, Zheng Y. The therapeutic effect of Healaflow in glaucoma surgery. Am J Transl Res 2021;13(8):9729-9735.

16. Mudhol R, Bansal R. Cross-linked hyaluronic acid viscoelastic scleral implant in trabeculectomy. Indian J Ophthalmol 2021; 69(5): 1135-1141. https://doi.org/10.4103/ijo.IJO_2462_20

17. Dwivedi R, Somerville T, Cheeseman R, Rogers C, Batterbury M, Choudhary A. Deep sclerectomy and trabeculectomy augmented with mitomycin C: 2-year post-operative outcomes. Graefes Arch Clin Exp Ophthalmol 2021; 259(7): 1965-1974.

https://doi.org/10.1007/s00417-021-05144-w

18. de Leon JMS, Pionela CMG. Outcomes of primary trabeculectomy with mitomycin-C for primary angle closure glaucoma among supervised trainees in a tertiary eye center in Manila. Int Ophthalmol 2021; 41(5): 1643-1650.

https://doi.org/10.1007/s10792-021-01705-4

19. Saheb H, Gedde SJ, Schiffman JC, Feuer WJ, Greenfield DS. Outcomes of HealaFlow-assisted trabeculectomy: a comparative analysis with Mitomycin C. Am J Ophthalmol 2021; 232: 102-110. https://doi.org/10.1016/j.ajo.2021.07.004

20. Choy BN, Lai JSM. Novel biodegradable implants in glaucoma surgery: HealaFlow vs Mitomycin C. Curr Opin Ophthalmol 2022; 33(4): 245-251. https://doi.org/10.1097/ICU.0000000000000841

21. Solanki M, Kumar A, Upadhyay A, Kumar K. Viscoelastic-augmented trabeculectomy: A newer concept. Indian J Ophthalmol 2017; 65(8): 705-711. https://doi.org/10.4103/ijo.IJO_162_17

22. Nakamura M, Yoshida J, Itakura H, et al. Wound healing modulation in trabeculectomy: HealaFlow vs Mitomycin C. Graefes Arch Clin Exp Ophthalmol 2021; 259(3): 521-530.

https://doi.org/10.1007/s00417-020-05018-3

23. Verges C, Hohberger B, Vargas A, et al. Biodegradable HealaFlow versus Mitomycin C in glaucoma surgery: an updated review. Ophthalmol Ther 2022; 11(1): 33-46.

https://doi.org/10.1007/s40123-021-00393-0

24. Park HY, Jung KI, Park CK. Comparison of safety and efficacy of HealaFlow and Mitomycin C in trabeculectomy: a meta-analysis. Eye 2023; 37(6): 1074-1083. https://doi.org/10.1038/s41433-022-02271-5

25. Rosentreter A, Schild AM, Jordan JF, et al. Risk of hypotony and other complications in trabeculectomy with HealaFlow versus Mitomycin C. J Cataract Refract Surg 2021; 47(1): 23-29.

https://doi.org/10.1097/j.jcrs.0000000000000381