- Design
- Ophthalmic Technology Assessment of 11 studies
- Population
- Patients having trabeculectomy, mostly for primary open-angle glaucoma
- Primary outcome
- IOP success, medication burden and complications
- Effect
- Similar success and complication rates; some favoured injection for bleb morphology
An American Academy of Ophthalmology panel reviewed 11 studies (six rated level I) comparing sub-Tenon's or subconjunctival injection of mitomycin C with sponge application during trabeculectomy.
Success, pressure reduction and medication burden were similar between techniques, as were complications such as bleb leak, hypotony and choroidal effusion. Some studies reported fewer post-operative 5-fluorouracil injections and more diffuse, less vascular blebs after injection, and one reported more reoperations after sponge application. Success rates varied widely across studies because definitions and follow-up differed.
The practical upshot is that either technique is acceptable. Injection may give more favourable bleb morphology, which some surgeons will weigh, but there is no basis to call one safer.
- Either injection or sponge delivery of mitomycin C is supported by level I and II evidence.
- Injection may produce a more diffuse, lower and less vascular bleb.
- Use a technique and concentration you are trained in, and document both.
- Monitor blebs for late leaks and hypotony whichever method is used.
Why it matters
It removes the pressure to change a familiar technique without evidence of better outcomes.
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