Efficacy and Safety of Trabeculectomy in Pakistani Patients with Mitomycin C delivered via Sub Tenon Injection versus Conventional Soaked Sponges

Abstract

Abstract Purpose: Trabeculectomy with Mitomycin C (MMC) is a frequent choice for surgical intervention to effectively control intraocular pressure (IOP) in glaucoma. This study aims to compare the efficacy and safety of trabeculectomy in Pakistani patients with MMC administration by sponges versus sub-tenon injection. Methods: A retrospective cohort study was conducted to analyze consecutive patients who underwent trabeculectomy with MMC at Aga Khan University Hospital, Karachi, Pakistan Complete success was defined as achieving an IOP of ≤ 15 mmHg at least one year one year post-surgery without additional anti-glaucoma medication. Qualified success was defined as IOP≤ 15 mmHg at least one year one year post-surgery with additional anti-glaucoma medications. Results: A total of 102 eyes from 67 patients were included in the study. Among the participants, 49%underwent trabeculectomy with MMC using the traditional sponges, while 51% underwent trabeculectomy with MMC via sub-tenon injection. At 12 months, the study revealed an overall success rate of 59% in the subtenon injection group versus 41% in the sponges group (p = 0.159) in controlling IOP. However, the sub-tenon injection group exhibited a trend towards lower IOP, achieving 100% complete surgical success versus 37% in the conventional sponges group along with displaying a lower frequency of post-operative complications (57% in the sponges-treated group vs 43% in the sub tenon injection group). Conclusion: Both MMC application techniques in trabeculectomy demonstrate similar efficacy and safety in Pakistani patients. The sub-tenon injection method emerges as a potentially safer alternative, offering benefits in lowering IOP and ensuring complete treatment success without the need for additional medications.