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Evaluating the efficacy of short duration Mitomycin C in safe surgery system trabeculectomy combined with cataract surgery

Authors Khandelwal R, Bijlani M, Raje D, Rathi A

Received 10 November 2018

Accepted for publication 6 March 2019

Published 22 May 2019 Volume 2019:13 Pages 849—857


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Scott Fraser

Rekha Khandelwal,1 Madhavi Bijlani,1 Dhananjay Raje,2 Anand Rathi1

1Department of Ophthalmology, NKP Salve Institute of Medical Sciences & Lata Mangeshkar Hospital, Nagpur 440019, India; 2MDS Bio Analytics, Nagpur 440010, India

Purpose: To compare the efficacy of 0.2 mg/ml Mitomycin C (MMC) applied for 1-minute versus 2-minutes in patients undergoing combined surgery for primary glaucoma coexistent with cataract.
Materials and methods: This was a randomized controlled clinical trial of 63 patients operated on for primary glaucoma (POAG or PACG) with visually significant cataract. All patients underwent safe surgery system trabeculectomy with manual small incision cataract surgery (MSIC) and implantation of PC IOL. Patients were randomized into intra-operative MMC 0.2 mg/ml for 1-minute (study group) and MMC 0.2 mg/ml for 2-minutes (control group). Success was measured on the basis of two different intraocular pressure (IOP) goals (IOP ≤21 mmHg, IOP ≤18 mmHg) and mean IOP reduction from baseline at the end of 12 months.
Results: At 12 months, significant decreases in mean IOP were observed in both groups (P<0.001).The mean IOP reduction was 31.33±9.06% in the study group, as compared to 43.32±9.38% in the control group (P<0.001). The overall success for IOP ≤21 mm Hg was 80.5% in the study group and 90.9% in the control group (P<0.05). Kaplan-Meier analysis showed an insignificant difference in overall success rates of the two groups.
Conclusion: The IOP reduction with 2-minute MMC (0.2 mg/ml) is more effective than 1-minute MMC after 12 months. It offers a decrease in anti-glaucoma medications and substantial visual recovery in combined surgery done for primary glaucoma coexistent with cataract.

Keywords: glaucoma, combined surgery, Mitomycin C, trabeculectomy, safe surgery system trabeculectomy

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