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PubMed1996

Histological grading of carcinoma in situ of the bladder: its clinical significance in patients who underwent intravesical mitomycin C and doxorubicin sequential therapy.

PURPOSE: The clinical behavior of carcinoma in situ of the bladder seems rather complicated. Although some have advocated the histological grading of carcinoma in situ, to our knowledge no sufficient clinical information has been reported. Therefore, we evaluated the clinical significance of histological grading of carcinoma in situ of the bladder. MATERIALS AND METHODS: From January 1984 to December 1991, 58 patients with carcinoma in situ of the bladder were treated initially with intravesical mitomycin C and doxorubicin sequential therapy. Of the patients 20 had grade 2 and 38 had grade 3 anaplasia according to the modified World Health Organization grading system. Those who failed the initial therapy received another course of mitomycin C and doxorubicin sequential therapy or intravesical bacillus Calmette-Guerin. RESULTS: Following initial therapy, 13 patients (65%) with grade 2 and 28 (74%) with grade 3 disease achieved a complete response. Subsequent intravesical therapy resulted in complete response in 17 patients (85%) with grade 2 and 31 (82%) with grade 3 cancer. The local recurrence rate was higher in the grade 2 than in the grade 3 cases after a median followup of 48 months (range 10 to 84). The recurrent tumor configuration was significantly different between the 2 groups. Papillary cancer recurred only in grade 2 cases, while only nodular cancer recurred in grade 3 cases. The progression-free and survival curves were slightly higher in grade 2 than in grade 3 cases, although the difference was not significant. CONCLUSIONS: There may be some difference in response to initial intravesical chemotherapy and the local recurrence rate between grades 2 and 3 carcinoma in situ, both of which are detrimental to grade 2 lesions. Moreover, it appears likely that grade 2 carcinoma in situ is a precursor of papillary high grade cancer and grade 3 carcinoma in situ is a precursor of nodular cancer. However, patient prognosis in the 2 groups was not significantly different.

Administration, Intravesical↗
PubMed2006

The effect of repeat transurethral resection on recurrence and progression rates in patients with T1 tumors of the bladder who received intravesical mitomycin: a prospective, randomized clinical trial.

PURPOSE: We compared the outcomes of repeat transurethral resection plus intravesical mitomycin C with initial transurethral resection of bladder plus intravesical MMC in patients with newly diagnosed pT1 transitional cell carcinoma of the bladder in terms of recurrence, progression and overall survival. MATERIALS AND METHODS: Of 148 newly diagnosed patients with T1 bladder cancer 142 were prospectively randomized in 2 groups between January 2001 and January 2005. A total of 74 patients underwent second TURB and received adjuvant MMC intravesically (group 1) and 68 patients received adjuvant MMC following the initial TURB (group 2). All repeat TURB operations were performed 2 to 6 weeks following initial TURB. Patients with incomplete resection, Cis or muscle invasive disease were excluded from study. The first dose of mitomycin C (40 mg per week for a total of 8 weeks) was instilled intravesically in all patients during the first 24 hours after the last surgery. RESULTS: Mean followup was 31.5 months (range 6 to 48) with no difference between the 2 groups. The rate of recurrence-free survival was 86.35% (SE 0.4%), 77.67% and 68.72% in group 1, and 47.08%, 42.31% and 37.01% in group 2 for the first, second and third year, respectively (overall 74.32% vs 36.76%, log rank 0.0001). Recurrence was observed in 19 of the 74 (25.68%) patients in group 1 and in 43 of the 68 (63.24%) patients in group 2. Ten of the 19 (52.63%) patients in group 1 and 35 of the 43 (81.39%) patients in group 2 had recurrence within 12 months. Recurrence was observed in 17.6%, 25% and 60% of patients with G1, G2 and G3 tumors, respectively, in group 1. The same rates for group 2 were 25%, 64% and 90%. The RFS rate was significantly worse in the high grade group (G2 and G3) (p <0.001). Progression was observed at 4.05% for group 1 compared to 11.76% for group 2 (log rank 0.0974). OS was 91.89% and 89.71% in group 1 and 2, respectively (log rank 0.732). CONCLUSIONS: The high recurrence rate in patients who did not undergo ReTUR is due to a high residual tumor rate following initial TURB. The benefit of ReTUR is especially true for high grade tumors. Since intravesical MMC was present in both groups, this study has shown that intravesical chemotherapy does not compensate for inadequate resection. Progression does not seem to be affected by ReTUR although there was a trend favoring the ReTUR group. We recommend ReTUR for patients with primary high grade T1 disease to achieve better recurrence-free survival.

Administration, Intravesical↗
PubMed1993

Technique of mitomycin C instillation in the treatment of upper urinary tract urothelial tumors.

The use of topical agents in the treatment and prophylaxis of transitional cell carcinoma of the bladder is well described. Several physicians have reported the use of these materials in the upper urinary tract for treatment of transitional cell carcinoma. We present our treatment protocol using mitomycin C as topical therapy following endoscopic resection of superficial urothelial tumors of the renal pelvis or ureter. A total of 7 patients was treated during the last 4 years. No systemic side effects due to perfusion with mitomycin C occurred. We believe that our treatment method provides a safe means of delivering topical agents to the upper urinary tract and suggest its use when such treatment is believed to be necessary.

Aged↗
PubMed1983

Subsequent tumor analysis of 36 patients who have received intravesical mitomycin C for superficial bladder cancer.

We studied 36 patients with stages O and A (Tis, Ta and T1) bladder cancer who had received 8 weekly doses of 30 or 40 mg. mitomycin C as definitive therapy. Of this group 16 had failed thiotepa therapy and 13 had grade III tumors (6 multifocal carcinoma in situ). The complete response rate at 12 weeks was 45 per cent (negative biopsy and cytology), while an additional 33 per cent had a partial response. Response did not correlate with tumor grade or stage. Patients who had failed thiotepa therapy were less likely to have a complete response, although the over-all response rate was identical to patients who had either not received prior chemotherapy or were not clear thiotepa failures. Followup of these patients indicates that the complete responders were benefited by this regimen since the subsequent recurrence rate was reduced when compared prior to initiation of mitomycin C. Most of these patients received monthly maintenance therapy.

Adult↗
PubMed2002

Efficacy and safety of mitomycin-C in primary trabeculectomy: five-year follow-up.

PURPOSE: To examine the 5-year complications and results of primary trabeculectomy with mitomycin-C (MMC). DESIGN: Retrospective, noncomparative interventional case series. PARTICIPANTS: One hundred twenty-three eyes that underwent primary trabeculectomy with MMC between December 1991 and March 1995. METHODS: All patients received standard trabeculectomy performed by one of two surgeons, using a Weck cell-soaked pledget of MMC, 0.25, 0.33, or 0.5 mg/ml, for 0.5 to 5 minutes. Laser suture lysis was performed postoperatively for intraocular pressure control. MAIN OUTCOME MEASURES: The incidence of complications, including hypotony with or without maculopathy, bleb leak or blebitis, pressure control, and medication reduction at yearly intervals. RESULTS: Mean preoperative and year 5 postoperative intraocular pressures (IOP) were 25.79 and 9.91 mmHg (P < 0.05, paired t test). Hypotony (IOP < 6) occurred in 42.2% of eyes after a mean follow-up of 26.1 months. Hypotony maculopathy occurred in 8.9% of eyes at mean follow-up of 33.7 months. Bleb leak occurred in 14.6% of eyes at a mean follow-up of 27.9 months. Blebitis occurred in 5.7% of eyes at a mean follow-up of 35.4 months, and endophthalmitis occurred in 0.8% of eyes at 15 months; 14.9% of eyes lost 4 lines of visual acuity. The single predictor for the development of late-term hypotony was IOP 1 month after operation (P < 0.05). CONCLUSIONS: Primary mitomycin trabeculectomy significantly lowers IOP at 5 years but is associated with a high incidence of delayed hypotony.

Antibiotics, Antineoplastic↗
PubMed2003

Silicone nasolacrimal intubation with mitomycin-C: a prospective, randomized, double-masked study.

OBJECTIVE: To determine if mitomycin-C (MMC) application during silicone intubation (SI) can effectively substitute for dacryocystorhinostomy (DCR) or Jones tube insertion. DESIGN: A prospective, randomized, double-masked study. PARTICIPANTS: Twenty-four patients (7 males, 17 females; aged 2-69 years) with 27 eyes (three bilateral cases) with an obstructed lacrimal system who were candidates for DCR or Jones tube. METHODS: All study patients underwent SI with application in a randomized, double-masked fashion of MMC or placebo, with the former receiving 0.2 mg/ml MMC for 2 minutes before SI. MAIN OUTCOME MEASURES: Clinical assessment of tearing and discharge; Schirmer I and II tests at 1, 3, 6, and 12 months; and the need for eventual DCR or Jones tube insertion. RESULTS: Follow-up ranged from 13 to 23 months (mean, 18 months; median, 17 months). Seven of the 12 eyes in the MMC group and 8 of the 15 eyes in the placebo group had a successful outcome and remained symptom free. The difference was not statistically significant (P = 0.79). Dacryocystorhinostomy or Jones tube was performed in five eyes in the MMC group and in seven eyes in the placebo group 3 to 18 months later; all had successful outcome and no complications. Untoward effects of MMC application included a slit canaliculus and a transient conjunctival injection. A successful outcome using this combined technique does not appear to correlate with age, gender, laterality, and intraoperative bleeding observed at the punctum or for the duration of symptoms. CONCLUSIONS: Mitomycin-C application during SI did not benefit outcome. Complications from such application were mild and infrequent.

Adolescent↗
PubMed1992

Effect of brief exposure to mitomycin C on viability and proliferation of cultured human Tenon's capsule fibroblasts.

PURPOSE: The purpose of this study is to determine why a single intraoperative dose of mitomycin C (MMC) appears to promote the success of glaucoma filtration surgery. METHODS: Human Tenon's capsule fibroblasts were exposed to MMC and 5-fluorouracil (5-FU) in vitro at the concentrations and durations of exposure used clinically. Cell proliferation was assessed by quantification of 3H-thymidine uptake. Cell viability was studied using a sulfarhodamine B cell protein stain and by trypan blue exclusion. RESULTS: Neither MMC (0.4 mg/ml) nor 5-FU (40 mg/ml) were cytocidal. Both 1- and 5-minute exposures to MMC were antiproliferative. A 1-minute exposure to 0.4 mg/ml inhibited 3H-thymidine uptake by 77%. For the 5-minute exposure, 3H-thymidine uptake was inhibited by 50% at 0.06 mg/ml and by 90% at 0.4 mg/ml. For 5-FU, 3H-thymidine uptake was inhibited by 50% at 10 mg/ml and by 64% at 40 mg/ml. CONCLUSIONS: Mitomycin C probably does not improve the success of filtration surgery by killing fibroblasts. The ability of a brief exposure to MMC to improve filtration surgery may be due to an almost complete inhibition of proliferation. Alternatively, it may be due to sustained tissue binding, effects on other components of wound healing, such as cell migration and extracellular matrix production, or effects on the vasculature. A 1-minute exposure may be as effective as a 5-minute exposure.

Cell Division↗
PubMed1992

Intraoperative mitomycin versus postoperative 5-fluorouracil in high-risk glaucoma filtering surgery.

In a randomized clinical trial, the authors compared the use of postoperative subconjunctival injections of 5-fluorouracil (5-FU) in 19 eyes with a single intraoperative application of subconjunctival mitomycin (MMC) at the filtering site in 20 eyes at high risk for failure of glaucoma filtering surgery. Six months after surgery, intraocular pressures averaged 10.9 +/- 5.3 mmHg (mean +/- standard deviation) in the MMC-treated eyes versus 14.2 +/- 5.5 mmHg in the 5-FU-treated eyes (P = 0.08) and were less than or equal to 12 mmHg in 60.0% of MMC-treated eyes and 21.1% of 5-FU-treated eyes (P = 0.03). Mitomycin-treated eyes were receiving an average of 0.3 +/- 0.5 medications for intraocular pressure control, and 5-FU-treated eyes were receiving an average of 1.1 +/- 1.1 medications (P = 0.01). Drug-induced corneal epithelial defects were seen in nine 5-FU-treated eyes and in no MMC-treated eyes (P = 0.0004). These results suggest that intraoperative MMC may be a viable alternative to postoperative 5-FU, with lower overall intraocular pressures, decreased dependence on postoperative ocular antihypertensive medications, and decreased corneal toxicity.

Adult↗
PubMed1992

Mitomycin concentration in rabbit and human ocular tissues after topical administration.

The authors measured mitomycin C (MMC) concentrations in ocular tissues with high-performance liquid chromatography. Mitomycin C concentration after a single subconjunctival injection of the drug in rabbit eyes showed a rapid decrease with a half-life of 0.18 to 0.30 hours for the conjunctiva and 0.20 to 0.45 hours for the sclera at the injection site. Irrigating the ocular surface with 200 ml of saline after MMC application reduced the initial drug concentration to one fifth in the sclera and to one fifteenth in the conjunctiva but did not change the half-life. The MMC concentration in human trabeculectomy specimens obtained immediately after MMC application (0.2 mg/0.5 ml) and irrigation was 5.4 to 12.0 micrograms/g with a mean of 8.4 micrograms/g, a level similar to that in the rabbit sclera immediately after the irrigation after administration of the same MMC dose. These results indicate that MMC disappears rapidly from the ocular tissues and that irrigating the tissues significantly reduces the tissue concentration of MMC.

Administration, Topical↗
PubMed1995

An ultrasound biomicroscopic study of filtering blebs after mitomycin C trabeculectomy.

PURPOSES: To investigate the relation between filtering bleb function and ultrasound biomicroscopic images, and to establish a new classification system for filtering blebs according to these images. METHODS: After trabeculectomy with mitomycin C, the filtering blebs of 117 eyes from 117 patients with various types of glaucoma were examined using ultrasound biomicroscopy. Four parameters of the images-intrableb reflectivity, visibility of the route under the scleral flap, formation of a cavernous fluid-filled space, and bleb height-were correlated with the level of intraocular pressure (IOP). RESULTS: Reflectivity inside the bleb and visibility of a route under the scleral flap were highly associated with IOP control. Blebs were classified into four categories according to the four measured parameters: type L (low-reflective), type H (high-reflective), type E (encapsulated), and type F (flattened). Eyes with good IOP control had mainly type L blebs. Type E and type F blebs were seen mostly in eyes requiring additional medication. CONCLUSION: The structure inside a filtering bleb is visible by ultrasound biomicroscopy, and bleb function is significantly associated with its ultrasound biomicroscopic image in eyes trabeculectomized with adjunctive mitomycin C.

Adolescent↗
PubMed1996

Slit-lamp needle revision of failed filtering blebs using mitomycin C.

PURPOSE: The purpose of the study is to determine the efficacy and safety of Mitomycin C (MMC) augmented slit-lamp needle revision of failed filtration surgery. METHODS: The authors retrospectively reviewed the charts of 62 patients (62 eyes) (age, 72 +/- 15 years) with failed filtration surgery who underwent needle revision using MMC. A mixture of 0.01 ml of MMC (0.4 mg/ml) and 0.02 ml of bupivacaine with epinephrine was injected subconjunctivally. Twenty to 30 minutes later, a 30-gauge needle was used to perforate the area of subconjunctival fibrosis and re-establish flow. RESULTS: Overall, 118 needing procedures (mean, 1.9 +/- 1.4 revisions per eye; range, 1-7) were performed on 62 eyes (mean follow-up, 9.9 +/- 3.7 months; range, 4.5-20.1 months). Thirty-six patients (58.1%) were needled once and 26 patients (41.9%) underwent more than 1 needling procedure. Intraocular pressure decreased from 24.1 +/- 6.4 mmHg (range, 18-44) before surgery to 11.5 +/- 4.8 mmHg (range, 1-26) at last follow-up (P = 5.51 x 10(-21)). Antiglaucoma medications decreased from 1.6 +/- 1.0 to 0.3 +/- 0.6 (P = 3.8 x 10(-14)). Successful single-needling procedure was highly correlated with race (white) and past conventional glaucoma filtration surgery of more than 4 years. Complications included serous choroidal detachment (10 eyes), suprachoroidal hemorrhage (1 eye), bleb leak (5 eyes), iris blocking sclerostomy (2 eyes), hyphema (2 eyes), corneal abrasion (2 eyes), and hypotony (1 eye). CONCLUSION: Mitomycin needle revision appears to be an extremely effective way to revive failed filtration surgery. The incidence of complications compares favorably to trabeculectomy with MMC.

Adult↗
PubMed1996

Combined cataract extraction with intraocular lens implant and mitomycin-augmented trabeculectomy.

PURPOSE: Cataract and glaucoma commonly coexist in elderly patients and present complex treatment options. This study investigates the results of simultaneous treatment of both conditions using phacoemulsification with posterior chamber lens implant and mitomycin-augmented trabeculectomy (combined surgery). METHODS: A retrospective analysis was performed of 56 consecutive patients who had undergone combined surgery. Fifty-one (91%) of 56 patients had fornix-based conjunctival flaps resutured at the limbus. A variety of postoperative interventional techniques (mechanical and pharmacologic) were used to encourage the achievement of successful filtering blebs. RESULTS: All patients had follow-up of at least 12 months. The mean preoperative intraocular pressure (IOP) was 20.2 mmHg (range, 14-43 mmHg) and the mean postoperative IOP was 10.7 mmHg (range, 4-17 mmHg). Fifty-three (95%) of 56 patients had IOPs of 15 mmHg or less at the completion of follow-up. All except two patients (96%) were able to discontinue all glaucoma medications. The filtering blebs that resulted from the fornix-based conjunctival flap procedures were predominantly large, diffuse, and noncystic. Best-corrected visual acuity was 20/40 or better in 47 (84%) of 56 of patients. CONCLUSION: Control of IOP and improvement of visual acuity can be achieved in a high percentage of patients with coexisting cataract and glaucoma by performing combined surgery using intraoperative mitomycin and fornix-based conjunctival flaps resutured to the limbus. The filtering blebs illustrated a distinctive morphology compared with blebs resulting from limbus-based conjunctival flap procedures.

Aged↗
PubMed1997

Hypotony maculopathy after filtering surgery with mitomycin C. Incidence and treatment.

PURPOSE: Hypotony maculopathy after glaucoma filtering surgery with adjunctive mitomycin C has been reported to occur in 3% to 14% of cases. The authors evaluated its incidence when using a corneal safety-valve incisior intended to reduce its occurrence. The authors also evaluated a technique for reversing hypotony maculopathy by reoperation using two sets of stitches in the scleral flap, with one set tied tightly to temporarily raise the intraocular pressure, stretch the sclera, and flatten chorioretinal folds. METHODS: The authors reviewed the results of 699 procedures performed between April 1991 and October 1994. All were performed or supervised by one surgeon (PFP). RESULTS: Hypotony maculopathy developed in 9 (1.3%) of 699 eyes. There was a statistically significant higher incidence in primary filters (4%) as compared to secondary filters or combined procedures. After revision, eight (89%) of nine recovered visual acuity of greater than or equal to 20/30 and the mean intraocular pressure was 14.5 +/- 4 mmHg at a mean follow-up of 15 months. CONCLUSION: The incidence of hypotony maculopathy after glaucoma filtering surgery with mitomycin C using a corneal safety-valve incision is less than that reported in the literature without this incision. There is an increased risk in myopes, young patients, and primary filters. Early intervention with the described scleral flap revision technique usually allows restoration of prefiltration visual acuity without compromise of bleb function.

Adult↗
PubMed1997

Limbus- versus fornix-based conjunctival flaps in combined phacoemulsification and mitomycin C trabeculectomy surgery.

PURPOSE: The authors compared the effectiveness of limbus- and fornix-based conjunctival flaps in patients undergoing combined phacoemulsification, intraocular lens implantation, and mitomycin C trabeculectomy. METHODS: The authors conducted a retrospective review of the records of 52 consecutive eyes of 45 patients who underwent combined surgery with limbus- and fornix-based conjunctival flaps. All surgery was by done by one surgeon on predominantly white patients in a suburban glaucoma subspecialty practice. Seven patients had both limbus- and fornix-based surgery, permitting fellow eye comparisons in these patients. All patients had at least 6 months and a median of 17 months follow-up. None of the eyes that were operated on had undergone intraocular surgery previously. RESULTS: No clinically significant difference in postoperative pressure reduction, bleb survival, or visual acuity was seen between the fornix- and limbus-based groups. Results in the fellow eye comparison subgroups were similar. The mean intraocular pressure decreased from 20.4 mmHg before surgery to a mean of 12.4 mmHg at the last follow-up visit. Forty-seven (90.3%) of 52 eyes had a final best-corrected visual acuity of 20/ 40 or better. Forty eyes (76.9%) no longer needed antiglaucoma medications at the end of follow-up. Five eyes had intraoperative posterior capsule rupture; all of these occurred in the limbus-based group. Shallow serous choroidal effusions were more common in the fornix-based group, but none were clinically significant. No difference in postoperative astigmatism between the limbus- or fornix-based group was seen. Intraoperative pupilloplasty, synechialysis, or postoperative neodymium:YAG capsulotomy had no appreciable effect on final intraocular pressure or bleb survival. Endophthalmitis, aqueous misdirection, or hypotony maculopathy did not develop in any patient. CONCLUSION: The effectiveness of limbus- and fornix-based conjunctival flaps appears to be similar. The limbus-based technique may result in a higher incidence of posterior capsular rupture, but the safety of limbus- and fornix-based flaps is otherwise similar. Combined phacoemulsification and mitomycin C trabeculectomy appears to be safe and effective for treating selected patients with coexisting glaucoma and cataract.

Aged↗
PubMed2000

Trabeculectomy with mitomycin-C in the treatment of pediatric glaucomas.

PURPOSE: To evaluate the effectiveness and safety of trabeculectomy with mitomycin-C (MMC) in the management of childhood glaucomas. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: All patients less than 18 years of age who underwent trabeculectomy with MMC from June 1991 through October 1997 were included. METHODS: The medical records of 29 consecutive patients (29 eyes) were reviewed. Data collected during routine patient follow-up were analyzed. Surgical outcome was evaluated using Kaplan-Meier life-table analysis. MAIN OUTCOME MEASURES: Clinical outcome assessment included intraocular pressure (IOP) control, visual acuity, and identification of complications. Successful IOP control was defined as 5 mmHg < or = final IOP < or = 21 mmHg, with or without antiglaucoma medications and without further glaucoma surgery or loss of light perception. Outcomes for the group of patients with primary infantile glaucoma were compared with those for the group with secondary glaucomas. RESULTS: Mean patient age was 6.4 +/- 4.4 years (range, 0.2-15.3 years). A variety of primary and secondary glaucomas were represented. Mitomycin-C (0.5 mg/ml) on a surgical sponge was applied to the episcleral surface for an average of 3.8 +/- 1.0 minutes (range, 1.5-5.0 minutes). Mean follow-up time for patients categorized as successes was 25.1 +/- 16.0 months (range, 5.5-59.7 months). The 12-, 24-, and 36-month life-table success rates for IOP control were 82%, 59%, and 59% respectively. There was no difference between the primary infantile glaucoma group and the secondary glaucoma group with respect to length of follow-up, rate of successful IOP control, and incidence of complications. Five patients (17%) experienced late bleb-related infection (BRI) at an average of 27.9 +/- 18.1 months (range, 5.4-55.5 months) after surgery. Other complications included hyphema, retinal detachment, late-onset bleb leak, flat anterior chamber, chronic hypotony, decompression retinopathy, suture abscess, and phthisis. CONCLUSIONS: Trabeculectomy with MMC may be useful in the management of childhood glaucomas in which goniotomy, trabeculotomy, or both have failed. However, the high incidence of BRI in this series over an extended follow-up interval dictates caution in using MMC as an adjunct in pediatric trabeculectomy.

Adolescent↗
PubMed1999

Ab-interno goniotrabeculotomy versus mitomycin C trabeculectomy for adult open-angle glaucoma: a 2-year randomized clinical trial.

OBJECTIVE: To evaluate the effect of ab-interno goniotrabeculotomy (AIGT) on the intraocular pressure (IOP) in adult patients with primary open-angle glaucoma (POAG), compared with the effects of mitomycin C trabeculectomy (MT). DESIGN: Prospective, randomized, clinical trial. PARTICIPANTS: Thirty-two eyes of 32 patients with medically uncontrolled POAG. INTERVENTION: Standard limbus-based trabeculectomy with adjunct mitomycin C (0.3 mg/mL for 3 minutes) in 16 eyes of 16 patients; AIGT was performed in 16 eyes of 16 patients. The groups were matched for age, preoperative IOP, duration of preoperative antiglaucoma treatment, use of preoperative beta-blockers and parasympathomimetics, and use of beta-blockers in the fellow eye. The IOP (average of the two highest values measured in the diurnal curve, from 8 AM to 6 PM, every 2 hours) and complications were recorded 1, 3, 6, 12, 18, and 24 months after surgery. MAIN OUTCOME MEASURES: Identification of complications and IOP. RESULTS: All patients were followed up for 24 months. More postoperative complications occurred in the MT group during the 2-year follow-up. One month after surgery, IOP was 10 +/- 1.46 mmHg (range, 8-13) in the MT group and 12.12 +/- 1.63 mmHg (range, 8-14) in the AIGT group (Student's t test, P = 0.001). Three months after surgery, IOP was 11.5 +/- 1.59 mmHg (range, 8-14) and 12.75 +/- 1.57 mmHg (range, 10-16) in the MT and AIGT groups, respectively (Student's t test, P = 0.033). From the 6th to the 24th postoperative month, no statistically significant difference in IOP was found between the two groups. At the end of follow-up, 14 of 16 eyes (87.5%) of the AIGT group and 13 of the 16 eyes (81.25%) of the MT group showed an IOP < or = 14 mmHg. CONCLUSION: Ab-interno goniotrabeculotomy appears to be a viable and safe surgical treatment for adult POAG. More extended follow-up, however, and a larger series of patients are needed to ascertain the actual effectiveness of this procedure in adult POAG.

Anterior Chamber↗
PubMed1999

Use of mitomycin C with conjunctival autograft in pterygium surgery in Asian-Canadians.

OBJECTIVE: To determine whether using mitomycin C (MMC) before applying conjunctival autograft is better than conjunctival autograft alone in preventing the recurrence of pterygia in an Asian-Canadian population. DESIGN: Nonrandomized, retrospective, comparative case series. PARTICIPANTS: A total of 159 patients were included in the study. Seventy patients (76 eyes) received MMC (0.25 mg/ml for 1 minute) with conjunctival autograft; 89 patients (98 eyes) received conjunctival autograft alone. INTERVENTION: All patients had primary (first-occurrence) pterygia excised and conjunctival autograft applied with or without MMC adjunct. MAIN OUTCOME MEASURES: Recurrence of pterygia was monitored for up to 1 year after the operation. Any complications (e.g., scleral thinning and necrosis) were documented. RESULTS: Patients' pterygia were examined on presentation and were graded 1 through 3. Grade 1 pterygia were fibrovascular proliferations extending up to one quarter the diameter of the cornea; grade 2 extended between one quarter to one half the distance across the cornea; and grade 3 extended beyond the visual axis. In the more severe pterygia group (grades 2 and 3 combined), there was significantly less pterygium recurrence in the MMC/autograft group (7%) compared with the autograft alone-treated group (26%). There was no significant difference in recurrence between groups for less severe grade pterygia (grade 1). The recurrence rate of all pterygia in the MMC/autograft group was 9% compared with 18% for the conjunctival autograft group. This difference was not statistically significant, however, because of a small sample size. There were no significant complications in either group and no difference between groups in complication rates. CONCLUSIONS: The authors suggest using MMC in patients with more severe pterygia as an adjunct to conjunctival autograft to lower the recurrence rate. Combining the use of MMC with conjunctival autograft allows for decreased dosage and time of intraoperative exposure of mitomycin, thereby making it safer for application.

Asia↗