Intraoperative Injection Versus Sponge-Applied Mitomycin C During Trabeculectomy In Glaucoma: A Systematic Review And Meta-Analysis.

Prcis: This study highlights intraoperative mitomycin C (MMC) injection in trabeculectomy with higher success rate and reduction in glaucoma medications, however, no difference in mean IOP at 1 year or safety profile, compared to MMC sponge.

Purpose: To compare the efficacy and safety of intraoperative injection of mitomycin C (MMC) versus conventional MMC-soaked sponges in patients undergoing trabeculectomy.

Methods: Pubmed, Cochrane, and Embase were searched for studies published until December 2023 comparing injection and sponge techniques during trabeculectomy. Main outcomes of interest were postoperative mean intraocular pressure (IOP) at 6 months, complete surgical success (mean IOP 5-21 mmHg without medication), postoperative number of antiglaucoma medications ≥12 months, and postoperative complications. This study was registered in PROSPERO, CRD42023494096.

Results: A total of 1665 eyes from 17 studies (9 randomized controlled trials [RCT]) were included, of which 723 (43.42%) received intraoperative injection of MMC. The mean IOP at 6 months was significantly lower in the injection group (mean difference [MD]= -0.93; 95% CI -1.85 - -0.01). Also, the incidence of complete surgical success at ≥6 months was higher in the injection group (OR=1.79; 95% CI 1.33-2.40). There were no significant differences between groups for postoperative complications (OR=1.01, 95% CI 0.69-1.49). Conversely, analysis of RCTs only showed a significant reduction in the number of medications for glaucoma control at ≥12 months with injection (MD= -0.37; 95% CI -0.60- -0.14).

Conclusion: Intraoperative MMC injection had greater rate of complete surgical success and reduction in the number of medications. However, there was no significant difference in mean IOP at 12 months between groups. MMC injection was as safe as sponge application in trabeculectomy.