Krommes G., Lieb W., Grehn F.

Univ.-Augenklinik, Josef-Schneider-Str. 11, D-97080 Würzburg

Background: We routinely use 8x8 mm polyvinylacetate sponges to apply local Mitomycin C (MMC) if needed in trabeculectomy. Measurements of size and fluid uptake were performed to achieve standardisation of the applied dose. We report about 58 cases, that underwent this procedure between the years 1996 and 2000.
Methods: Thin polyvinylacetate sponges were cut into 8x8 mm pieces. Using a high precision balance the sponges were first weighed dry and then filled with three drops of 0.2 mg/ml MMC of a standardised 2 ml syringe, giving the results of the exact dose. During trabeculectomy we saturated the sponge with three drops of 0.2 mg/ml MMC and placed it on the sclera for three minutes. 58 eyes of 56 patients suffering of risky glaucoma and being operated by this standardised procedure, were analysed in retrospect having a follow-up-control for an average of 57.6 weeks after operation.
Results: Using three drops of 0.2 mg/ml MMC a sponge takes up a total dose of 17.81 ± 1.52 µg MMC. None of the 56 patients has developed an endophthalmitis. Once we had to handle a leaking bleb leading to a blebitis and once a chronic hypotony. We observed 13 times a choroidal detachment. The average tension was reduced from 36.2 mmHg to 12.7 mmHg at the time of dismissal and 14.5 mmHg at the last out-patient'svisit. 33 cases (56.9%) developed an encapsulated bleb leading either to a 5-FU therapy (29 cases, 50.0%) or to a bleb-needling (13 cases, 22.4%). Laser suture lysis was performed on 15 eyes (25.9%).
Conclusion: Controlling the dose of MMC in a standardised procedure seems to be essential to a successful outcome in trabeculectomy. Moreover the intensified postoperative care is of crucial importance (Y. Mutsch, DOG 1998, J. Bretzke, DOG 1999).

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