Intraoperative injection versus sponge-applied mitomycin C during trabeculectomy : a systematic review and meta-analysis /
Jose Gabriel Recio, Rudolf Christian Palma and Manolito Reyes.
- Fairview, Quezon City: Department of Ophthalmology, FEU-NRMF, 2022.
- 25 pages: illustration, tables; (in folder) with flash drive (soft copy).
Includes appendices and bibliographical references.
Abstract: To determine the efficacy and safety of subconjunctival injection versus sponge-applied mitomycin C during trabeculectomy Systematic review and meta-analysis Data from 7 randomized controlled trials and case series studies We searched PubMed, The Cochrane Library, and Google scholar for studies that compared subconjunctival injection of Mitomycin-C (MMC) vs sponge-soaked application method, published up to June 30, 2022. NHLBI Quality Assessment Tools were used to evaluate the included studies. Mean difference for the 1-month postoperative IOP, 6-month postoperative IOP, 12-month postoperative IOP, final mean IOP reduction, bleb height, extent and vascularization and endothelial cell count changes, Odds ratio for the complications. Outcome measures were reported with a 95% confidence interval (CI), and P < 0.05 was considered statistically significant. Analysis was performed using Microsoft Excel and Review Manager software. Risk of bias of the studies showed low to moderate risk. In random effects model, the pooled mean difference showed: 1-month post op IOP -0.86 (95% CI: [-1.84, 0.11], P 0.08)., 6-month post op IOP 0.81 (95% CI: [-1.75, 0.14], P 0.10, 12-month post op IOP -0.04 (95% CI: [-1.61, 1.53], P 0.96, and final mean IOP -1.16 (95% CI: [-3.89, 1.56], P 0.40). Mean difference of bleb morphology revealed: height -0.35 (95% CI: [-0.50, -0.20], P <0.00001), extent 0.29 (95% CI: [0.17, 0.41], P <0.00001), and vascularization -0.47 (95% CI: [-0.65, -0.28], P <0.00001). Post-operative endothelial cell count showed -28.25 (95% CI: [-128.20, 71.70], P <0.58). Odds ratio of complications was -28.25 [-128.20, 71.70]. There were no significant difference in the mean IOP after 1,6 and12 months and mean IOP reduction of the intraoperative injection method and sponge soaked MMC. Blebs after sub tenon injection of MMC tended to be lower, more diffused and less vascularized. Endothelial cell count changes and complications in both methods were also comparable. Intraoperative injection of MMC is as effective as conventional sponge application.