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   Table of Contents      
LETTER TO THE EDITOR
Year : 2021  |  Volume : 69  |  Issue : 1  |  Page : 179-180

Response to comments on: Intraoperative injection versus sponge—applied Mitomycin C during trabeculectomy: One-year study


Department of Glaucoma, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Tirunelveli, S.N. High Road, Tirunelveli Junction, Tamil Nadu, India

Date of Web Publication15-Dec-2020

Correspondence Address:
Dr. Devendra Maheshwari
Department of Glaucoma, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Tirunelveli, S.N. High Road, Tirunelveli Junction - 627 001, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_2044_20

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How to cite this article:
Maheshwari D, Kanduri S, Rengappa R, Kadar MA. Response to comments on: Intraoperative injection versus sponge—applied Mitomycin C during trabeculectomy: One-year study. Indian J Ophthalmol 2021;69:179-80

How to cite this URL:
Maheshwari D, Kanduri S, Rengappa R, Kadar MA. Response to comments on: Intraoperative injection versus sponge—applied Mitomycin C during trabeculectomy: One-year study. Indian J Ophthalmol [serial online] 2021 [cited 2021 Jan 16];69:179-80. Available from: https://www.ijo.in/text.asp?2021/69/1/179/303289



Dear Editor,

We would like to thank you for showing interest and highlighting certain points in our study on “Intraoperative injection versus Sponge applied Mitomycin C during Trabeculectomy”.[1],[2]

The present study was designed to evaluate the safety and efficacy of Mitomycin C (MMC) injection versus sponge during trabeculectomy. Primary trabeculectomies were performed with Mitomycin C during the period of the study. It's a prospective analysis of patients who underwent Trabeculectomy with Mitomycin C.

Most of the cases in our case series were primary (POAG &PACG) glaucoma cases and few secondary glaucoma included were steroid induced glaucoma & Pseudo exfoliation glaucoma. Cases like uveitic, neovascular, and traumatic glaucoma were excluded because these cases are more pertinent for poorer trabeculectomy outcome.

Trabeculectomy with antimetabolites (mitomycin C or 5-fluorouracil), has a low long-term success rate in NVG (not higher than 33%) and fails mainly due to fibrous tissue obstruction (neovascular membrane seals internal ostium and spreads into the filtering passage) or external scarring and conjunctival fibrosis, even with antimetabolites.[3],[4]

There were conflicting aspects regarding the use of antiproliferative agents in uveitic glaucoma. There were few studies of trabeculectomy with Mitomycin-C (MMC) in uveitic eyes in the current literature, and interestingly, the results indicated no obvious advantage in the control of IOP over 5-fluorouracil.[5],[6]

In our study, we did not notice any significant post-operative events in early 2 weeks. In our practice we routinely admit patient for a day following surgery, examination done same day, at 1st day of post op, 2 weeks, 4 weeks, 6 weeks, 2 months, and 3 months. Whenever needed patients were called for frequent follow up.

Our study was small case series, main aim of our study was to evaluate the safety and efficacy of Intraoperative injection of MMC against conventional sponge-applied MMC. However, bleb morphology in injection group was more diffuse, less vascularized and shallower bleb similar to Esfandiari He et al.[7] but these results were not statistically significant in comparing both groups.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Maheshwari D, Kanduri S, Rengappa R, Kadar MA. Intraoperative injection versus sponge-applied mitomycin C during trabeculectomy: One-year study. Indian J Ophthalmol 2020;68:615-9.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Latsaheb B, Sarma P, Tayab S, Sangma C. Comments on: Intraoperative injection versus sponge-applied mitomycin C during trabeculectomy: One-year study. Indian J Ophthalmol 2021;69:178-9.  Back to cited text no. 2
  [Full text]  
3.
Rodrigues GB, Abe RY, Zangalli C, Sodre SL, Donini FA, Costa DC, et al. Neovascular glaucoma: A review. Int J Retina Vitreous 2016;2:26.  Back to cited text no. 3
    
4.
Nakatake S, Yoshida S, Nakao S, Arita R, Yasuda M, Kita T, et al. Hyphema is a risk factor for failure of trabeculectomy in neovascular glaucoma: A retrospective analysis. BMC Ophthalmol 2014;26:14-55.  Back to cited text no. 4
    
5.
Carreño E, Villarón S, Portero A, Herreras JM, Maquet JA, Calonge M. Surgical outcomes of uveitic glaucoma. J Ophthalmic Inflamm Infect 2011;1:43-53.  Back to cited text no. 5
    
6.
Kalogeropoulos D, Sung VC. Pathogenesis of uveitic glaucoma. J Curr Glaucoma Pract 2018;12:125-38.  Back to cited text no. 6
    
7.
Esfandiari H, Pakravan M, Yazdani S, Doozandeh A, Yaseri M, Conner IP. Treatment outcomes of Mitomycin C-augmented trabeculectomy, sub-tenon injection versus soaked sponges, after 3 years of follow-up. Ophthalmol Glaucoma 2018;1:66-74.  Back to cited text no. 7
    




 

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