Simultaneous subconjunctival and subscleral mitomycin-C application in trabeculectomy

Objective: of mitomycin-C in trabeculectomy. Design: A prospective, randomized study. To establish the efficacy and safety, of simultaneous subconjunctival and subscleral application Participants: Sixty-eight patients (68 eyes) with refractory glaucomas were included in the study. Interventions: Eyes were randomly assigned to receive intraoperative mitomycin-C (0.3 mg/ml) applied under the conjunctival flap (group 1), scleral flap (group 2), or under both flaps (group 3). Main Outcome Measures: Mean intraocular pressure (IOP), postoperative medications,visual acuity, filtering bleb appearance, and complications. Results: There was a significant difference in IOP at 6, 9, and 12 months after surgery among the three groups (P = 0.021, 0.026, and 0.033, respectively ANOVA). At 12 months, the mean IOP in group 3 was 9.8 +/- 3.7 mmHg compared with 13.4 +/- 5.5 mmHg in group 2. (P = 0.015) and 12.4 +/- 4.4 mmHg in group 1 (P = 0.039). Success rate (21 mmHg or less), number of antiglaucoma medications, and complications showed no statistical significant difference between the three groups at each postoperative visit. Conclusions: Mitomycin-C applied under the scleral flap may have an additional beneficial effect when combined with simultaneous subconjunctival exposure. (C) 2000 by the American Academy of Ophthalmology.