Mitomycin C by injection or sponge: similar trabeculectomy outcomes

Design

Ophthalmic technology assessment of 11 studies

Population

Patients having trabeculectomy with mitomycin C, mostly primary open-angle glaucoma

Primary outcome

IOP success, pressure reduction and complications

Effect

Complete success 40–91% (injection) vs 18–87% (sponge); complications similar

An American Academy of Ophthalmology evidence assessment reviewed 11 studies (six level I, two level II, three level III) comparing mitomycin C delivered by sub-Tenon or subconjunctival injection with application on sponges during trabeculectomy.

Complete success ranged from 40% to 91% with injection and 18% to 87% with sponges, a spread reflecting different definitions and follow-up. Pressure reductions overlapped. Bleb leak, hypotony and choroidal complications did not differ. Two studies reported fewer postoperative 5-fluorouracil injections with injection, and several described more diffuse, less vascular blebs.

The assessment concludes that either method is supported by level I and II evidence.

Surgeons can choose by preference and setup; injection may offer a bleb advantage, but not a proven difference in pressure control or safety.

• Use either injection or sponge mitomycin C at trabeculectomy.
• Consider injection where a diffuse, low-profile bleb is a priority.
• Standardise concentration and technique within a unit to audit outcomes.
• Record antimetabolite use and concentration in the operation note.

Why it matters

It removes pressure to switch technique while noting a possible bleb benefit with injection.

Don't overread it

Studies varied widely in definitions and concentrations, so no pooled comparison was possible.

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