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Intraoperative MMC may lower aqueous shunt survival in children younger than 2 years

Ophthalmology. 2009;116(10):1862-1865.

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Intraoperative mitomycin C use reduced 2-year survival rates of a polypropylene aqueous shunt device in young glaucoma patients, according to a study.

The study authors set out to evaluate the influence of intraoperative MMC on survival of the Ahmed glaucoma valve (AGV, New World Medical).

"We speculate that MMC-induced tissue death can stimulate a reactive fibrosis around the AGV in very young eyes," the authors said. "Although intraoperative MMC application has a role in pediatric trabeculectomy, we do not recommend its use in AGV implantation for children, particularly those less than 2 years of age."

The retrospective comparative series included 31 eyes of 27 patients; 23 patients underwent unilateral AGV implantation and four patients had bilateral implantation. Mean age at the time of implantation was 11.1 months. Intraoperative MMC was applied at the implantation area in 16 eyes and not applied in 15 eyes.

Implants survived a mean 22.15 months in non-MMC eyes and 16.25 months in MMC eyes. The difference was statistically significant (P = .025). Cumulative implant survival at 2 years after surgery was 80% in non-MMC eyes and 31.3% in MMC eyes. The difference was statistically significant (P = .001), the authors said.

Additionally, between 3 and 24 months after surgery, at 3-month intervals, eyes treated with MMC required more glaucoma medications than eyes not treated with MMC. However, the difference was not statistically significant, the authors said.