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PubMed1996

A randomized multicenter trial of adjuvant therapy in superficial bladder cancer: transurethral resection only versus transurethral resection plus mitomycin C versus transurethral resection plus bacillus Calmette-Guerin. Participating Clinics.

PURPOSE: A randomized multicenter trial was done to compare transurethral resection only to transurethral resection plus adjuvant mitomycin C and bacillus Calmette Guerin (BCG) instillation for treatment of superficial bladder cancer (stage pTa/1 grades 1 to 3 except primary stage pTa grade 1). MATERIALS AND METHODS: Included in the study were 337 patients with superficial stage pTa/1 grades 1 to 3 bladder cancer except primary stage pTa grade 1 tumors. One group underwent transurethral resection alone. Mitomycin C (20 mg./50 ml. sodium chloride) was given every 2 weeks during year 1 and once a month during year 2. BCG (120 mg/50 ml. sodium chloride was instilled once a week for 6 weeks and once a month for 4 months. RESULTS: At a median followup of 20.2 months, a decrease in recurrence rate was noted for both drug instillations compared to transurethral resection only. The relative risk of recurrence was 0.508 after mitomycin C and 0.618 after BCG instillation compared to transurethral resection alone. There was no significant difference between the mitomycin C and BCG instillations. The progression rate was comparable in all 3 therapy groups, with an estimated common progression rate of 4.22% per year. Side effects occurred most frequently during or after BCG instillation, most often consisting of cystitis. One patient required cystectomy because of ulcerating cystitis and a prostatic abscess subsequent to unsuccessful tuberculostatic therapy. There were no systemic complications. CONCLUSIONS: Our study showed a positive effect of adjuvant chemotherapy and immunotherapy on decreasing tumor recurrence rate. No influence was observed concerning progression rate, which was low overall.

Adjuvants, Immunologic↗
PubMed1993

Bladder damage in mice after single and repeated intravesical instillations of mitomycin C or doxorubicin.

Functional and histological damage after intravesical administration of mitomycin C or doxorubicin were studied in mouse bladders. Dosing schedules were based on those commonly used in the clinic, and bladder function was assessed from changes in urination frequency. Repeated weekly instillations of 1 mg./ml. mitomycin C induced a transient three-fold increase in Frequency Index (FI) with recovery to control levels within 3 weeks. Weekly instillations of 6 mg./ml. doxorubicin also resulted in a three-fold increase in FI, but lower doses produced only minimal changes. There was, again, full recovery within 3 weeks. Our experiments indicate that repeated intravesical instillations of mitomycin C or doxorubicin are well tolerated, with rapid recovery from functional damage within a few weeks of cessation of therapy. There was significantly less damage after repeated instillations of clinically relevant doses of doxorubicin than mitomycin C.

Administration, Intravesical↗
PubMed1999

Comparison of HepG2 feeder cells generated by exposure to gamma-rays, X-rays, UV-C light or mitomycin C for ability to activate 7,12-dimethylbenz[a]anthracene in a cell-mediated Chinese hamster V79/HGPRT mutation assay.

The cell-mediated Chinese hamster V79/HGPRT mutagenicity assay is an established in vitro testing method. Although gamma-irradiated human HepG2 hepatoma cells have been used recently for chemical activation, an alternative is now needed due to scheduled retirement of the available gamma-source. X-irradiation, 254 nm UV-C light and mitomycin C were examined as possible HepG2 mitotic inhibitors, and treated cells compared for activation of 7, 12-dimethylbenz[a]anthracene (DMBA). In colony-forming assays, V79 and HepG2 cells differed in sensitivity to DMBA, with V79 survival declining sharply between 1-2.5 microM (LD50=1.75 microM) while HepG2 survival decreased gradually, beginning at 0.01 microM DMBA (LD50=0.045 microM). When HepG2 feeder cells generated by each method were included in V79/HGPRT mutation assays, activation of 1 microM DMBA was found to vary according to the mitotic inhibitor used, with mutation frequencies decreasing in the order 4000 rads gamma-rays>25 microg/ml mitomycin C>4000 rads X-rays>25 J/m2 UV-C light. Only assays containing gamma-irradiated HepG2 cells generated an increase (2-3-fold) in mutation frequency when DMBA exposure was extended from 24 to 48 h. The effect of HepG2 preincubation with either Aroclor 1254 or DMBA on feeder cell activation of DMBA was also assessed using concentrations of Aroclor 1254 (10 microg/ml) or DMBA (1.0 microM) which were found to produce optimum induction of ethoxyresorufin-O-deethylase (EROD) activity (3.1-fold and 2-fold increases, respectively). Compared to results obtained with uninduced HepG2 cells, assays incorporating HepG2 cells activated by either Aroclor 1254 or DMBA produced slightly increased V79/HGPRT mutation frequencies after 24 h of exposure to mutagen; however, a 48 h incubation with mutagen in the presence of HepG2 preincubated with either Aroclor 1254 or DMBA resulted in higher mutation frequencies regardless of the mitotic inhibitor treatment. EROD activity was also induced 1.4-fold following exposure of HepG2 cells to mitomycin C alone. Although gamma-irradiation remains the treatment of choice for producing metabolically active HepG2 feeder cells, comparison of the alternatives tested suggests that mitomycin C would be a convenient and suitable replacement.

9,10-Dimethyl-1,2-benzanthracene↗
PubMed1995

Long-term monitoring of 486P 3/12 antigen pattern (quantitative immunocytology) before, during, and after mitomycin C prophylaxis in patients with superficial bladder cancer.

OBJECTIVES: Quantitative pattern of 486p 3/12 antigenicity in urine cytologies (Quic) of patients with superficial bladder carcinoma during operation and chemoprophylaxis was evaluated to determine the duration of prophylaxis on an individual patient-oriented basis. METHODS: Thirty-six patients with superficial bladder carcinoma during chemoprophylaxis (43 [range, 3 to 90] weeks of mitomycin C) have been evaluated monthly for 99 (range, 36 to 141) weeks. RESULTS: Only 6 of 36 patients (16.7%) had tumor recurrence after mean follow-up of 67.5 weeks. During mitomycin instillations, only 5 patients converted from positive to repeated negative Quic. None of them developed tumor. Thirty-one did not convert and only 6 of them developed recurrent tumor. CONCLUSIONS: Quic seems not to be a reliable marker during mitomycin prophylaxis. After mitomycin prophylaxis, a repeated positive Quic, however, was associated with a high risk of recurrence occurring in 3 of 8 Quic-positive patients. A repeated negative or alternating Quic identified a lower risk group, showing 3 recurrent tumors in 28 patients only. We conclude that Quic cannot be used during, but after, prophylaxis to identify risk patients requiring further treatment. During prophylaxis, its value is limited to a subgroup of patients developing negative Quic, for whom prophylaxis can be stopped individually.

Adult↗
PubMed2003

Transconjunctival mitomycin-C in needle revisions of failing filtering blebs.

PURPOSE: To report the efficacy and safety of transconjunctival mitomycin-C as an adjunct to needle revision of failing filtering blebs. DESIGN: Retrospective, consecutive, noncomparative interventional case series. PARTICIPANTS: Forty-one patients (42 eyes) undergoing bleb revisions by a single surgeon at a single institution from May 1997 to January 2001. METHODS: The authors retrospectively reviewed charts of 42 eyes that underwent needle revision of the failing filtering bleb using transconjunctival application of mitomycin-C. Needling of the bleb was performed with a 25-gauge needle. The site of the needle puncture was sutured and followed by application of transconjunctival mitomycin-C (0.5 mg/ml) by means of a sponge left in contact with the conjunctival epithelium for 6 minutes. A group of patients received additional subconjunctival injections of 5-fluorouracil in the postoperative period. Success was defined as a reduction in intraocular pressure of 30% without the use of antiglaucoma medications and no further surgical procedures to control intraocular pressure. MAIN OUTCOME MEASURES: Intraocular pressure, visual acuity, complications, number of glaucoma medications used at the final visit. RESULTS: Mean preoperative intraocular pressure was 22.1 +/- 8.0 mmHg, which was reduced by 9.6 +/- 7.9 mmHg to a mean postoperative intraocular pressure of 12.5 +/- 6.1 mmHg. Mean follow-up was 17.6 +/- 13.5 months. Kaplan-Meier survival analysis showed a probability of continued success at 12 months of 76.1%, and at 24 months of 71.6%. The most common complication was hyphema in 7.1% of patients. Twenty-six eyes also received postoperative injections of 5-fluorouracil. CONCLUSIONS: Transconjunctival mitomycin-C may enhance success of the needling procedure in failing filtering blebs.

Adult↗
PubMed2003

Subconjunctival mitomycin C as adjunctive therapy before pterygium excision.

PURPOSE: To evaluate the safety and efficacy of subconjunctival mitomycin C as adjunctive therapy before pterygium surgery. DESIGN: Prospective noncomparative case series. PARTICIPANTS: Thirty-six eyes of 36 patients. INTERVENTION: Thirty-six eyes of 36 patients prospectively received 0.1 ml of 0.15 mg/ml mitomycin C subconjunctivally injected into the head of the pterygium 1 month before bare sclera surgical excision. MAIN OUTCOME MEASURE: Recurrence of pterygia. RESULTS: The pterygia resolved in 34 (94%) of 36 eyes, with a recurrence rate of 6% over a mean follow-up of 24.4 months. No wound-healing complication developed in any patient. CONCLUSIONS: Subconjunctival mitomycin C is an effective treatment before pterygium excision. Subconjunctival injection allows exact titration of mitomycin C delivery to the activated fibroblasts and minimizes epithelial toxicity.

Adult↗
PubMed1992

Serious complications of topical mitomycin-C after pterygium surgery.

BACKGROUND: The use of topical mitomycin (mitomycin-C) as a medical adjunct to pterygium and glaucoma surgery is increasing. METHODS: The authors report on a series of 10 patients who experienced serious, vision-threatening complications associated with the use of this drug after pterygium surgery. RESULTS: Complications included severe secondary glaucoma (4 patients), corneal edema (3 patients), corneal perforation (1 patient), corectopia (2 patients), iritis (8 patients), sudden onset mature cataract (2 patients), scleral calcification (1 patient) and incapacitating photophobia and pain (8 patients). Two patients required penetrating keratoplasties and a third required three lamellar keratoplasties. Another patient underwent four additional surgeries including a conjunctival Z-plasty, scleral patch grafting, and conjunctival autografting before his intractable pain and photophobia resolved 15 months after the original surgery. Because of these complications, 6 patients required a total of 20 return visits to the operating room after their original pterygium surgery. In 5 eyes, visual acuity remained at 20/200 or less. Three of the six patients with the most severe complications had concomitant chronic external diseases (rosacea [3 patients], ichthyosis [1 patient], keratitis sicca [1 patient]). CONCLUSION: The authors urge extreme caution in the use of mitomycin. If mitomycin is used, the lowest possible concentration should be applied for the shortest time period in an effort to avoid these complications. A prospective multicenter study of the ophthalmic use of this medication is needed.

Adult↗
PubMed1993

Safety and efficacy of mitomycin C trabeculectomy in southern India. A short-term pilot study.

PURPOSE: Glaucoma is a major cause of blindness in developing nations. Medical and laser therapy have limitations in this environment. Filtration surgery alone often fails in young, darkly pigmented, individuals. The authors, therefore, evaluated the safety and efficacy of filtration surgery, using topical mitomycin C, in patients undergoing trabeculectomy in India. METHODS: A short-term pilot study used mitomycin C at the time of trabeculectomy in a population of southern Indians with various forms of glaucoma. A single 5-minute intraoperative application of 0.4 mg/ml mitomycin C was given to 76 consecutive patients requiring filtration surgery for the control of intraocular pressure (IOP). All patients were admitted for 6 days and were seen at 6-week intervals for a minimum of 18 weeks. RESULTS: The mean preoperative IOP was 35.3 +/- 9.6 mmHg. Postoperative IOP control was attained in 93.4% of patients as defined by an IOP of 20 mmHg or less without additional glaucoma medications (or an IOP reduction > 25% if the preoperative IOP was < or = 20 mmHg). No corneal epithelial defects or wound leaks were seen. The major complications were cataract formation and a decreased visual acuity in ten (13%) eyes. CONCLUSION: Mitomycin C-aided trabeculectomy was highly successful in controlling IOP in this darkly pigmented population and may become an important adjunct in the treatment of glaucoma in developing countries.

Administration, Topical↗
PubMed1994

The use of low-dose mitomycin C for prevention of recurrent pterygium.

BACKGROUND: The administration of high doses of topical mitomycin C after pterygium excision causes a variety of complications. METHODS: Seventy-five patients who had advanced or recurrent pterygia underwent excision of pterygia, leaving the sclera bare. Patients were randomized in a masked fashion into three groups of 25 patients each. Patients in group 1 received topical 0.01% mitomycin C for 5 days, patients in group 2 received 0.02% mitomycin C for 5 days, and those in group 3 were treated with 1200 rad beta-irradiation. Patients were followed by a surgeon who was masked to the patient treatment. The mean follow-up period was 15.3 months. RESULTS: The recurrence rate after pterygium surgeries was 8% in group 1, 4% in group 2, and 20% in group 3. There were no statistical differences between the study groups. Delay of epithelialization for 8 weeks in one patient and degenerative calcification of conjunctiva 18 months after surgery in another patient, both from group 2, were the only complications in this study. CONCLUSION: This study indicates the advantage of 0.01% mitomycin C for post-operative prevention of recurrence of pterygium.

Administration, Topical↗
PubMedDate not supplied

The mitomycin bioreductive antitumor agents: cross-linking and alkylation of DNA as the molecular basis of their activity.

This review focuses on the chemical and enzymatic aspects of the reductive activation of mitomycin C, its disulfide analogs KW-2149 and BMS-181174, and, in less detail, FR66979 and FR900482, newly discovered antitumor antibiotics related to mitomycins. Furthermore, structural aspects of DNA damage induced by these drugs in vitro and in vivo are described, including the chemical and conformational characteristics of DNA interstrand and intrastrand cross-links and monofunctional alkylation products, with emphasis on DNA adducts of mitomycin C. The DNA sequence specificity of the damage and its mechanism is reviewed. The relationship between the chemical and structural properties of the DNA damage on the one hand, and the antitumor and other biological activities of the mitomycins on the other, is discussed.

Alkylation↗
PubMed2000

Topical use of mitomycin C in laser myringotomy: an experimental study in rats.

OBJECTIVE: Ventilation tubes are used to a large extent for the treatment of otitis media with effusion. As this has some drawbacks, laser myringotomy was suggested as a treatment alternative. The use of laser has some advantages but its use is limited in prolonging the patency rate of myringotomy. Mitomycin C (MMC) is being used in some surgical applications to reduce stenosis as it has the property to inhibite activity of fibroblasts. We explored the use of mitomycin C as an adjunct in prolonging the patency rate in laser myringotomy on rats. METHODS: We performed laser myringotomy on both ears of 20 rats. We, then applied MMC with a concentration of 2 mg/ml on 10 rats to one of their ears (Group 1). In group 2 we used MMC with a concentration of 1 mg/ml. After a follow-up of 8 weeks we calculated the patency rate for the two groups and the total ears with MMC and without MMC. RESULTS: The mean patency rate observed for group 1 was found to be 6 weeks whereas for group 2, it was 5.8 weeks. The overall patency rate for the ears with and without MMC is 5.9 and 1.5 weeks, respectively. While there was a statistical difference between ears with and without MMC (P<0.01), there was no difference between the two groups according to concentrations. CONCLUSION: Mitomycin C has an adjunct effect in laser myringotomy in prolonging the patency rate of myringotomy on rats. Low concentrations of mitomycin C have the same effect in this issue.

Administration, Topical↗
PubMed1986

Suppression of migration inhibition factor (MIF) production by mitomycins in vitro.

The effects of a series of mitomycins in a modified version of the Migration Inhibition Factor (MIF) test were investigated. This modified assay, which uses monocytes of the mouse cell line WEHI3 as target cells for MIF, discriminates between effects on the migrating monocytes, the production of MIF by lymphocytes and the activity of the produced MIF. The 7-methoxy mitomycins were found to be more active than the 7-amino and 7-hydroxy derivatives in suppressing both the spontaneous migration of target monocytes and the MIF production by lymphocytes. Neither of the compounds had a significant effect on the activity of produced MIF. A relationship between the activities of the mitomycins and their lipophilicity and polarographic half-wave potential is discussed. Further attention is paid to the stability of the mitomycins under the test conditions and additional advantages of the modified MIF assay over related in vitro tests for cell-mediated immunity.

Animals↗
PubMed2003

Dose-response relationship of topically applied mitomycin C for the prevention of laser myringotomy closure.

OBJECTIVE: We sought to determine a dose-response curve for topical mitomycin C when used to prolong the patency of laser-assisted myringotomies. STUDY DESIGN AND SETTING: Bilateral myringotomies were performed using the argon laser in 40 guinea pigs with normal ears. Pledgets with (0.05, 0.2, 0.4, or 2.0 mg/mL) mitomycin C were applied topically. Monitoring consisted of weekly or biweekly otomicroscopy. RESULTS: As in previous studies, all saline-treated myringotomies closed by day 7. By day 14, all myringotomies (100%) in the 0.05 mg/mL group were closed. By contrast, all myringotomies (100%) remained patent in the 0.2 and 0.4 mg/mL treatment groups, and 56% of the myringotomies remained patent in the 2.0 mg/mL group at day 14. By day 56, all myringotomies were closed in the 2.0 mg/mL group, 5 (50%) myringotomies were patent in the 0.4 mg/mL group, and 1 (11%) myringotomy was patent in the 0.2 mg/mL group. The study was terminated on day 84 (12 weeks). At that time, only the 0.4 mg/mL group had patent myringotomies (n = 3; 30%). The highest dose (2.0 mg/mL) of mitomycin was significantly associated with otorrhea. Otorrhea also appeared to be associated with earlier myringotomy closure. CONCLUSION: There is a dose-response curve for topical mitomycin C when used for prolonging myringotomy patency in doses up to 0.4 mg/mL. Higher doses do not appear to prolong patency and are associated with greater otorrhea, suggesting middle ear toxicity.

Administration, Topical↗
PubMed2003

Postoperative concomitant irradiation and chemotherapy with mitomycin C and bleomycin for advanced head-and-neck carcinoma.

PURPOSE: In a prospective randomized clinical study, simultaneous postoperative application of irradiation (RT), mitomycin C, and bleomycin was tested in a group of patients with operable advanced head-and-neck carcinoma. It was expected that the planned combined postoperative therapy would reduce the number of locoregional recurrences and prolong survival. METHODS AND MATERIALS: A total of 114 eligible patients with Stage III or IV squamous cell head-and-neck carcinoma were randomized to receive postoperative RT alone (Group 1) or RT combined with simultaneous mitomycin C and bleomycin (Group 2). Patients were stratified according to the stage and site of the primary tumor and the presence or absence of high-risk prognostic factors. Primary surgical treatment was performed with curative intent in all patients. Patients in both groups were postoperatively irradiated to the total dose of 56-70 Gy. Chemotherapy included mitomycin C 15 mg/m(2) after 10 Gy and 5 mg of bleomycin twice a week during RT to the planned total dose of 70 mg. RESULTS: At 2 years, patients in the radiochemotherapy group had better locoregional control (86%) than those in the RT alone group (69%; p = 0.037). Disease-free survival and overall survival was also better in the radiochemotherapy group compared with the RT-alone group (76% vs. 60%, p = 0.099; and 74% vs. 64%, p = 0.036, respectively). Patients who benefited from chemotherapy were those with high-risk factors. CONCLUSION: The results of the present study indicate that concomitant postoperative radiochemotherapy with mitomycin C and bleomycin improves locoregional control and survival in patients with advanced head-and-neck carcinoma. The patients who benefited from chemotherapy were those with high-risk factors.

Adult↗
PubMed1996

Combined phacoemulsification and trabeculectomy with mitomycin-C.

PURPOSE: To examine the safety and efficacy of primary combined phacoemulsification, posterior chamber intraocular lens (IOL) implantation, and trabeculectomy with mitomycin-C (0.4 mg/ml) in patients with open-angle glaucoma and visually significant cataract. SETTING: University-hospital-based glaucoma referral practice. METHODS: In this study, data of 43 patients of a single surgeon were retrospectively analyzed. These consecutive patients had combined phacoemulsification, posterior chamber IOL implantation, and trabeculectomy with mitomycin-C. RESULTS: Thirty-eight patients (88%) had open-angle glaucoma and 5 (12%) pseudoexfoliative glaucoma. Thirty-eight patients (88%) had 12 months of follow-up; all had at least 6 months follow-up. Mean preoperative intraocular pressure (IOP) was 21.6 mm Hg +/- 6.8 (SD) (range 12.0 to 41.0 mm Hg) with 2.5 +/- 1.0 glaucoma medications. At last follow-up, mean IOP had decreased to 14.2 +/- 6.2 mm Hg (range 3.0 to 40.0 mm Hg) with 0.5 +/- 0.5 glaucoma medications. Twenty-one patients (55%) had an IOP of 15 mm Hg or less at 12 months. Best corrected visual acuity was 20/40 or better in 31 of 43 patients (72%) at last follow-up. A filtration bleb was noted in 33 of 40 patients (83%) at their last visit. Postoperative IOP spikes occurred in 17 patients (40%), transient hyphema in 12 (28%), transient wound leaks in 11 (26%), and superficial punctate keratopathy in 11 (26%). Three cases of persistent hypotony (IOP less than 5 mm Hg) and 1 case of epithelial downgrowth were also noted. CONCLUSION: Phacoemulsification with IOL implantation and combined trabeculectomy with mitomycin-C produced good visual acuity and excellent IOP control but resulted in some complications. The use of mitomycin-C in combined procedures does not appear to confer a significant benefit.

Antibiotics, Antineoplastic↗
PubMed2000

Preliminary results of intraoperative mitomycin-C in the treatment and prevention of glottic and subglottic stenosis.

Mitomycin-C is an antineoplastic antibiotic that acts as an alkylating agent by inhibiting DNA and protein synthesis. It can inhibit cell division, protein synthesis, and fibroblast proliferation. The purpose of this pilot study is to investigate intraoperative applications of topical mitomycin-C in treatment and prevention of glottic and subglottic stenosis. Eight patients with posterior glottic and/or subglottic stenosis were treated with endoscopic CO2 laser excision followed by topical application of 0.5 cc of 0.4 mg mitomycin-C per milliliter of saline for 4 minutes at the surgical site. After mean follow-up of 15 months (10-20) all patients had clinical improvement of their airway and resolution of their preoperative symptoms. No complications were noted in this study. Although a longer follow-up and further controlled studies are needed, the use of topical mitomycin-C may prove useful in the treatment and prevention of subsequent restenosis and scar formation in the larynx and trachea.

Adolescent↗
PubMed2001

The effect of C(5) cytosine methylation at CpG sequences on mitomycin-DNA bonding profiles.

Recent studies have documented that cytosine C(5) methylation of CpG sequences enhances mitomycin C (1) adduction. The reports differ on the extent and uniformity of 1 modification at the nucleotide level. We have determined the bonding profiles for mitomycin monoalkylation in two DNA restriction fragments where the CpG sequences were methylated. Three mitomycin substrates were used and two different enzymatic assays employed to monitor the extent of drug modification at the individual base sites. Drug DNA modification was accomplished with I and 10-decarbamoylmitomycin C (2) under reductive (Na2S2O4) condilions and with N-methyl-7-methoxyaziridinomitosene (3) under nonreductive conditions. The UvrABC incision assay permitted us to quantitate the sites of drug adduction, and the lambda-exonuclease stop assay provided a qualitative estimation of drug-DNA modification consistent with the UvrABC data. We learned that C(5) cytosine methylation (m5C) enhanced the extent of overall DNA modification. Using the UvrABC endonuclease assay, we found that modification by 1 increased 2.0 and 7.4 times for the two DNA restriction fragments. Analysis of the modification sites at the nucleotide sequence level revealed that guanine (G) was the only base modified and that the overall increased level of DNA adduction was due to enhanced modification of select m5CpG* (G* = mitomycin (mitosene) adduction sites) loci compared with CpG* sites: the largest differences reached two orders of magnitude. Significantly, not all CpG* sites underwent increased drug adduction upon C(5) cytosine methylation. The effect of C(5) cytosine methylation on the drug adduction profiles was less pronounced for G* sites located within dinucleotide sequences other than CpG*. We observed that DNA methylation often led to slightly diminished adduction levels at these sites. The different m5CpG* adduction patterns provided distinctive sequence-selective bonding profiles for 1-3. We have attributed the large differences in guanine reactivity to DNA structural factors created, in part, by C(5) cytosine methylation. The significance of these findings in cancer chemotherapy is briefly discussed.

Autoradiography↗
PubMed1999

Mitomycin C-augumented trabeculectomy with postoperative wound modulation in pediatric glaucoma.

PURPOSE: The purpose of this study was to evaluate mitomycin C-augmented trabeculectomy combined with postoperative subconjunctival 5-fluorouracil and laser suture lysis in the treatment of refractory pediatric glaucoma. METHODS: Twenty-one consecutive cases (17 patients) with refractory pediatric glaucoma treated with mitomycin C trabeculectomy (0.4 mg/mL for 3 to 5 minutes) and postoperative 5-fluorouracil, laser suture lysis, or both were retrospectively reviewed. Success was defined as intraocular pressure between 4 and 16 mm Hg without further glaucoma surgery or devastating complication. RESULTS: The median age of the study population was 2.6 years (range, 0.05 to 16 years). The overall success rate was 52.4%, with a median follow-up of 23 months for successful cases. Success rates for patients older than 1 year of age versus those younger than 1 year of age at surgery were 73% and 30%, respectively. Success rates for phakic versus aphakic eyes were 64% and 29%, respectively. Age and lens status, taken together, were significant predictors of outcome (P = .013). Reasons for failure in this study were uncontrolled intraocular pressure (8 cases), persistent wound leak (1 case), and endophthalmitis (1 case); the latter 2 cases required bleb excision. Other complications encountered included chorioretinal detachment, shallow anterior chamber, 5-fluorouracil toxicity, and cataract formation. No irreversible visual deficits could be attributed to the trabeculectomy procedure or subsequent complications in any of these cases. CONCLUSIONS: Mitomycin C-augmented trabeculectomy combined with postoperative suture lysis and 5-fluorouracil is a viable option for older phakic children with refractory glaucoma. This procedure has a lower success rate in infants and in aphakic eyes. Both early and late postoperative complications are common, and diligent lifelong long-term follow-up is needed to detect bleb leaks and infection. The addition of postoperative suture lysis and 5-fluorouracil to mitomycin C-augmented trabeculectomy did not provide any convincing improvement in the success of this procedure in pediatric patients with refractory glaucoma and may have increased the complication rate.

Adolescent↗