PREOPERATIVE MITOMYCIN-C SUBCONJUNCTIVAL INJECTION AND GLAUCOMA FILTERING SURGERY

Intraoperative mitomycin-C application has been well accepted recently as a useful adjunctive procedure to enhance the filtering effect in g laucoma surgery. However, the exact dose of mitomycin-C left after suc h a procedure in the ocular tissue is variable and unclear. It is impo rtant to determine such residual because of potential long-term toxici ty of mitomycin-C to the eye. Based on previous successful experience using preoperative mitomycin-e subconjunctival injection in the THC-YA G laser sclerostomy on rabbits, the effect of intraocular pressure (IO P) control and its clinical observation was studied in six eyes of six refractory and high risk glaucoma patients by subconjunctival 1.2 mu g to 3.6 mu g mitomycin-C injection 24 to 72 hours prior to classic, r outine, limbal-based trabeculectomy surgery. After 18 months of satisf actory clinical observation of the first eye for IOP, functioning bleb appearance and smooth clinical course, the same procedure was used on an additional five eyes, with a follow-up period of more than five mo nths. Average IOP was reduced from 27.8 mm Hg (range 24 to 34 mm Hg) p reoperatively to 9.5 mm Hg (range 5 to 14 mm Hg) postoperatively, with a smooth clinical course. The advantages of such preoperative subconj unctival mitomycin-C injection are emphasized here.