Topical mitomycin-C versus subconjunctival 5-Fluorouracil for management of bleb failure

ABSTRACT

To compare the efficacy and safety of topical mitomycin C [MMC] drops with that of subconjunctival 5-fluorouracil [5-FU] injections for management of early bleb failure after trabeculectomy or combined phacoemulsification and trabeculectomy with posterior chamber intraocular lens implantation [PT+PCIOL]. In a randomized comparative study, 37 eyes of 37 patients with impending early bleb failure received MMC 0.02% eye drops for 2 or 4 weeks [19 eyes] or subconjunctival 5-FU injections, 5 mg per dose [18 eyes]. Complete success was defined as 5 < IOP eyes versus 3 [16.7%] eyes, P = 0.017]. Mean preoperative IOP was 20.5 +/- 8.85 mmHg in the MMC group and 25.82 +/- 11.35 mmHg in the 5-FU group [P = 0.129], which was decreased to 13.2 +/- 6.1 and 10.6 +/- 4.8 mmHg respectively after 12 months [P = 0.159]. There was no significant difference between the study groups in terms of bleb extent [P = 0.170], height [P = 0.178] or vascularity [P = 0.366]. At the end of the study, complete success was achieved in 13 eyes [68.4%] in the MMC group and 14 eyes [77.8%] in the 5-FU group [P = 0.714]. The survival of success at 8 months [median follow-up] was 89.5% and 86.5% in the MMC and 5-FU groups respectively; the number of glaucoma medications [P = 0.707] and best-corrected visual acuity [P = 0.550] were also comparable. Complication rates were similar in the study groups [P = 0.140]. Topical MMC 0.02% has comparable safety and efficacy to subconjunctival 5-FU injections for management of early bleb failure. Topical MMC 0.02% drops are more convenient and can be initiated first, while 5-FU injections may be reserved for eyes with an insufficient response to topical MMC