An American Academy of Ophthalmology Ophthalmic Technology Assessment, published in Ophthalmology on 7 October 2026, reviewed 11 studies comparing mitomycin C delivered by sub-Tenon's or subconjunctival injection with mitomycin C applied on sponges during trabeculectomy. Six were rated level I evidence.
Complete success in pressure control ranged from 40% to 91% with injection and 18% to 87% with sponges, reflecting different definitions and follow-up rather than a clear difference. Pressure reductions overlapped. Rates of bleb leak, hypotony, choroidal effusion and haemorrhage did not differ significantly. Some studies found fewer 5-fluorouracil injections and more diffuse, lower and less vascular blebs after injection; one found more reoperations after sponges.
The practical conclusion is that either technique is supported. Injection allows more precise dosing and may give a more favourable bleb, while sponges are familiar and widely available. Surgeons in India, where trabeculectomy remains a mainstay of glaucoma surgery, can choose on familiarity and cost.
- Use either injected or sponge-applied mitomycin C during trabeculectomy according to experience
- Consider injection where a diffuse, low, less vascular bleb is a priority
- Standardise concentration and exposure within your unit whichever method you use
- Audit pressure success and bleb complications against published ranges
Why it matters
It removes pressure to change technique on efficacy grounds alone.
Don't overread it
The bleb-morphology advantage came from some studies only; overall success and safety were similar.
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