Intraoperative MMC may reduce success rate of glaucoma device surgery in young children

Treatment of congenital glaucoma can be challenging, especially in patients who need multiple surgical procedures. This retrospective study suggests that mitomycin-C (MMC) applied in the area of Ahmed glaucoma valve (AGV) implantation may reduce chances of surgical success in children. 

Researchers followed for two years 27 patients (31 eyes) implanted with an AGV at a mean age of 11.1 months. MMC was applied in16 (52 percent) patients, while the others received no MMC application. At two years, the non-MMC eyes demonstrated a significantly longer mean survival rate than the MMC-eyes (22.5 months versus 16.25 months). The non-MMC eyes also had a significantly higher two-year cumulative survival rate (80 percent) than the MMC eyes (31.3 percent). 

The authors point out a number of limitations of the study, including its retrospective nature and the greater number of cases in the MMC group at a higher risk for surgical failure, such as those with Peter's anomaly. Also, the group that received MMC had a higher number of patients with previous intraocular/conjunctival surgery - a factor that has an unknown impact on the success rate. Though the authors suggest that the S1 and S2 AGV have the same valve function, the surface area of their plates is significantly different. The study doesn't indicate how many patients who received MMC had the S1 implant, so it's unclear if this factor had an effect on the success rate. 

In conclusion, a prospective study may be needed to clarify whether or not MMC has a delirious effect on the success of glaucoma device surgery. Nonetheless, this study clearly shows that MMC was not beneficial when used with the Ahmed GDD.