Intraoperative Mitomycin C for Nonpenetrating Glaucoma Surgery A Systematic Review and Meta-analysis

Objective: To evaluate the efficacy and tolerability between nonpenetrating glaucoma surgery with (NPGS-MMC) and without (NPG S-noMMC) intraoperative mitomycin C application in the treatment of patients with open angle glaucoma. Methods: Pertinent studies were selected through extensive searches of the Cochrane Library, PubMed, Embase, and Chinese Biomedicine Database. Eight controlled clinical trials meeting the predefined criteria were systematically reviewed by meta-analysis. The main outcome measures were percentage intraocular pressure reduction and complete success rate. The pooled estimates were carried out in RevMan version 5.0 software. Results: The weighted mean differences of the percentage intraocular pressure reduction when comparing NPGS-MMC with NPGS-noMMC were 5.24% (95% confidence intervals: -3.24-13.72) at 6 months, 8.31% (4.33 to 12.30) at 12 months, 9.56% (4.88 to 14.24) at 24 months, and 14.45% (9.03 to 19.88) at 36 months. NPGS-MMC was associated with significant greater complete success rates compared with NPGS-noMMC, with a pooled risk ratio being 1.16 (1.05 to 1.27) at 6 months, 1.20 (1.05 to 1.38) at 12 months, 1.30 (1.05 to 1.61) at 24 months, and 1.36 (1.06 to 1.73) at 36 months. Intraoperative MMC was not associated with any drug-induced complications. Conclusions: The use of intraoperative MMC is a safe and effective additional step during nonpenetrating filtering surgery.