Purpose: To determine the efficacy and long term effects of diffuse intra-operative application of mitomycin C.
Methods: Records of 66 patients (77 eyes) having had a trabeculectomy with the adjunctive use of diffusely applied mitomycin C and with a follow-up period of greater than 3 years were reviewed. Mitomycin 0.25 or 0.5 mg/ml on Weck-cell sponge pieces was applied over a minimum area of 12 mm X 7 mm. Parameters reveiwed were success or failure of the trabeculectomy and the associated complications with particular reference to bleb leaks, blebitis or endophthalmitis.
Results: 77 eyes of 49 Black and 17 White patients were reviewed. Follow-up ranged from 3-9 years, average 5. Intraocular pressure control under 20 mm Hg occurred in all but one eyes. Average pre-op pressures were 27 mm Hg, average post-op pressure was 12. 80% of patients required no post-op medications. Bleb leaks occurred in 2 eyes and no blebitis or endophthalmitis occurred in any eye. One eye developed a retinal detachment and became phthisical.
Conclusion: Mitomycin applied on a single Weck-cell measuring 4.5 mm X 4.5 mm produces a small localized bleb, more likely to become thin and leak over time due to localized internal pressure. We have shown that diffuse application of mitomycin 12.5 mm X 7 mm produces blebs which control intraocular pressure and are less likely to leak when followed for an average of 5 years.