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Editors Selection IGR 9-4

Surgery: Meta-analysis of Surgery with MMC

Comment by Paul Palmberg on:

13314 Intra-operative mitomycin C for glaucoma surgery, Wilkins M; Indar A; Wormald R, Cochrane Database of Systematic Reviews, 2005; CD002897

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Using the Cochrane Register of Controlled Trials and its component databases ( e.g. MEDLINE), reference lists of articles and contact with researchers in the field, Wilkins et al. (258) found 11 randomized trials with 698 participants in which the use of intraoperative MMC had been compared to placebo in trabeculectomy surgery. In eyes with high risk of failure, the relative risk of failure with MMC was significantly reduced (RR = 0.32, 95% CI 0.20-0.53), as it was in primary filtering surgery (RR = 0.29, 95% CI 0.16-0.53). Although the RR was not significantly reduced in combined cataract and filtering surgery, the mean IOP was significantly lower at 12 months in combined procedures, as in the other two groups of trials. With respect to complications, there was some evidence that the use of MMC in phakic eyes increases the risk of cataract. None of the trials were large enough or of sufficient duration to address the long-term risk of bleb infection and endophthalmitis. Conclusion: This meta-analysis of 11 randomized trials (MMC vs placebo) convincingly demonstrates that the use of Mitomycin C results in significantly lower IOP across the spectrum of filtering procedures during the time span of the included studies, and a lower risk of failure in primary and complex filtering surgery.

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