EVALUATING THE EFFICACY OF MITOMYCIN C VERSUS 5-FLUOROURACIL IN TRABECULECTOMY FOR INTRAOCULAR PRESSURE CONTROL IN MEDICALLY UNCONTROLLED PRIMARY OPEN-ANGLE GLAUCOMA
Main Article Content
Keywords
Trabeculectomy,Mitomycin C, 5-Fluorouracil, Intraocular Pressure
Abstract
Background: Primary open-angle glaucoma(POAG) is one of the leading causes of blindness, and intraocular pressure (IOP) is the most important modifiable risk factor. Trabeculectomy is a standard surgical method used to control IOP, typically administered with concomitant application of anti-fibrotic agents such as Mitomycin C (MMC) and 5-Fluorouracil (5-FU) in an attempt to curb scarring, a complication that can lead to poor outcomes.
Objectives: To compare the effectiveness and safety of MMC with 5-FU as adjuncts in trabeculectomy for IOP control in medically uncontrolled POAG,assessing safety and long-term outcomes.
Study design: A prospective study.
Place and Duration of study: Department of Ophthalmology, Gaju Khan Medical College, Sawabi. The study was carried out over one year, from January 2024 to June 2024.
Methods: One hundred patients with medically uncontrolled POAG undergoing trabeculectomy were randomly assigned, with half receiving MMC and the other half 5-FU. The primary outcome was IOP at standard time frames following surgery. Secondary outcomes included IOP control and complication rates. Data were analyzed using SPSS 24.0.
Results: The mean age was 62.3± 7.1 years in the MMC group and 61.8 ± 6.9 years in the 5-FU group. Both groups had comparable baseline IOP (MMC: 28.4 ± 4.2 mmHg; 5-FU: 29.1 ± 4.5 mmHg; p = 0.23). At 12 months, the mean IOP was significantly lower in the MMC group (14.2 ± 3.1 mmHg) compared to the 5-FU group (16.5 ± 4.0 mmHg; p < 0.05). The MMC group showed a greater success rate (86%) versus the 5-FU group (72%) (p < 0.05).
Conclusion: In cases of medically uncontrolled primary open-angle glaucoma(POAG), trabeculectomy with mitomycin-C (MMC) achieves greater intraocular pressure (IOP) reduction compared to 5-fluorouracil (5-FU). Therefore, informed and confident clinical decision-making is essential for effective disease management.
References
2. Lam, D., & Wechsler, D. Z. (2021). Five-year outcomes of trabeculectomy and phacotrabeculectomy. Cureus, 13(1), e12947. https://doi.org/10.7759/cureus.12947
3. Tsai, J. C., & Wand, M. (2022). Neovascular glaucoma. In D. A. Albert, J. B. Miller, D. J. Kim, & A. U. Al-Moujahed (Eds.), Albert and Jakobiec's Principles and Practice of Ophthalmology (pp. 1769–1806). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-030-54907-2_108
4. Kandarakis, S., Kontaxakis, A., Dumas, L., Petro, P., Dritsas, K., Papaconstantinou, D., & Georgalas, I. (2022). Assessing safety and success after using bevacizumab, 5-fluorouracil or placebo in primary trabeculectomy: A prospective randomized placebo-controlled 1-year follow-up study. Cutaneous and Ocular Toxicology, 41(1), 25–32. https://doi.org/10.1080/ 15569527.2021.1952773
5. Baer, E. F., & Seymenoglu, R. G. (2021). Results of fluorouracil-augmented Xen45 implantation in primary open-angle and pseudoexfoliation glaucoma. International Ophthalmology, 41(3), 945–955. https://doi.org/10.1007/s10792-020-01576-0
6. Kapitsa, S., Tejaswini, S. U., Venkatesh, R., & Zebardast, N. (2024). Wound modulation in glaucoma surgery: The role of anti-scarring agents. Indian Journal of Ophthalmology, 72(3), 320–327. https://doi.org/10.4103/ijo.IJO_2139_23
7. Gallardo, M. J., Vincent, L. R., & Porter, M. (2022). Comparison of clinical outcomes following gel stent implantation via ab-interno and ab-externo approaches in patients with refractory glaucoma. Clinical Ophthalmology, 16, 2187–2197. https://doi.org/10.2147/OPTH.S371167
8. Arampinyokul, P., & Rojanamuangnit, K. (2025). Long-term surgical outcome of trabeculectomy with Mitomycin C: A comparison between primary and secondary glaucoma in Thailand. Clinical Ophthalmology, 19, 1299–1311. https://doi.org/10.2147/OPTH.S453764
9. Karaka, S., Onus, H., Hooker, M., & Yilmaz, O. F. (2024). Evaluation of deep sclerectomy and trabeculectomy in the treatment of glaucoma. European Eye Research, 4(2), 109–114. https://doi.org/10.4274/eer.galenos.2024.28274
10. Kinetic, M., Todorovic, D., Zecevic, R., & Volovici, T. S. (2023). High-frequency deep sclerectomy as adjunctive therapy in open-angle glaucoma patients. Ophthalmic Research, 66(1), 339–344. https://doi.org/10.1159/000533077
11. Khodeiry MM, Later AJ, Saied MS, Han Y, Lee RK. Primary slow-coagulation transscleral cyclophotocoagulation laser treatment for medically recalcitrant neovascular glaucoma. British Journal of Ophthalmology. 2023 May 1;107(5):671–676. https://doi.org/10.1136/bjophthalmol-2021-319757
12. An HN, Dinah NN, Thu HN, Van CN, Aunt T, Look Y, Ngoc HN, Do T. Comparing the safety and efficacy of phacogoniosynechialysis with phacotrabeculectomy in the management of refractory acute primary angle closure glaucoma with cataract: a multicenter randomized trial. Journal of Glaucoma. 2021 Jul 1;30(7):552–558. https://doi.org/10.1097/IJG. 0000000000001868
13. Sabinal E, Ingram Z, Odisheliáze N, El Helve H, Farah HK, Trzcinski J, Hall N, Solace Valle D. Comparing Outcomes of Trabeculectomy with Mitomycin C to 45-μm Gelatin Stent Placed Ab Externo with Open Conjunctiva. Ophthalmology Glaucoma. 2024 May 1;7(3):232–241. https://doi.org/10.1016/j.ogla.2023.11.005
14. Szigeti AA, Tome S, Jabber S, Lord F, Agouti Y, Singh H. Efficacy of ab-externo gelatin microstent implantation in primary and refractory glaucoma. Canadian Journal of Ophthalmology. 2023 Aug 1;58(4):328–337. https://doi.org/10.1016/j.jcjo.2022.02.012
15. Theophanous CN, Adagio E, Faros AV, Sondra D, Quid M. Management of severe epithelial versus fibrous down growth following trabeculectomy: Case report and literature review. American Journal of Ophthalmology Case Reports. 2021 Sep 1; 23:101183. https://doi. org/10.1016/j.ajoc.2021.101183
16. Agnail L, Figs M, Sacchi M, Oddone F, Villain E, Ferrari G, Pocatello C, Carnival C, Gucci P, Nubile M, Mastropasqua L. Managing the ocular surface after glaucoma filtration surgery: an orphan topic. Graefe's Archive for Clinical and Experimental Ophthalmology. 2024 Jul; 262(7):2039–2056. https://doi.org/10.1007/s00417-023-06333-5
17. Chew, A. C., Hon., H. M., Pereira, S. A., Aunt, T., Lin, H. C., Husain, R., Yi, B. P., Su, D. H., Chua, J., & Wong, T. T. (2024). Long-term outcomes of combined phacotrabeculectomy surgery in a Singapore tertiary hospital. Asia-Pacific Journal of Ophthalmology, 13(5), 100102. https://doi.org/10.1097/APO.0000000000000102
18. Kim KW, Ma A, Ng J, Choy P, Yip WW, Young AL. Successful corneal endothelium preservation in the management of epithelial down growth with 5-fluorouracil injections and membranectomy. BMC Ophthalmology. 2024 Oct 15;24(1):450. https://doi.org/10.1186/ s12886-024-03450-6
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Jehanzeb Khan
Associate professor Ophthalmology, Gajju Khan Medical College Swabi.
Syed Amir Hamza
Assistant Professor Ophthalmology Lady Reading Hospital Peshawar
Muhammad Waseem
Associate Professor Ophthalmology Jinnah Medical College Peshawar
Muhammad Rafiq
Associate professor ophthalmology Rehman medical institute Peshawar
Javed Rasul
Associate Professor, Department of Ophthalmology, Pak International Medical College Peshawar
Maria Sultan
Assistant Professor Ophthalmology KMU Hospital and Research Centre Peshawar