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Published in: Graefe's Archive for Clinical and Experimental Ophthalmology 4/2013

01-04-2013 | Glaucoma

Purified triamcinolone acetonide as antifibrotic adjunct in glaucoma filtering surgery

Authors: Barend Frits Theodorus Hogewind, Benjamin Pijl, Carel Benedict Hoyng, Thomas Theelen

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 4/2013

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Abstract

Background

The purpose of this study is to compare the effects of mitomycin C (MMC) and triamcinolone acetonide (TAC) during and after glaucoma filtering surgery.

Methods

Retrospective interventional consecutive case series. All eyes underwent primary guarded trabeculectomy with either MMC or sub-Tenon TAC injection. Intraoperative and postoperative complications up to 5 years after the filtering surgery were evaluated. Differences between the two regimens were tested for statistical significance.

Results

A total of 64 trabeculectomies, of which 39 with MMC and 25 with TAC, were compared. At the 5-year follow-up examination three of the eyes treated with MMC (7.7 %) and none of the eyes treated with TAC had an intraocular pressure of more than 18 mmHg (p = 0.08). In the MMC group, three eyes required repeated glaucoma surgery (7.7 %; one trabeculectomy, one Baerveldt drainage implant, one cyclodiode laser treatment), while this was two eyes in the TAC group (8.0 %; one Baerveldt drainage implant, one cyclodiode laser treatment) (p = 0.97).

Conclusion

The present study demonstrates that in primary trabeculectomy, the 5-year risk profiles of MMC and purified TAC are comparable, suggesting that as an antifibrotic agent TAC is at least as effective as MMC. Prospective randomized trials will need to confirm the agents’ relative long-term benefits.
Literature
1.
go back to reference Wilkins M, Indar A, Wormald R (2005) Intra-operative mitomycin C for glaucoma surgery. Cochrane Database Syst Rev CD002897 Wilkins M, Indar A, Wormald R (2005) Intra-operative mitomycin C for glaucoma surgery. Cochrane Database Syst Rev CD002897
2.
go back to reference Lee DA (1994) Antifibrosis agents and glaucoma surgery. Invest Ophthalmol Vis Sci 35:3789–3791PubMed Lee DA (1994) Antifibrosis agents and glaucoma surgery. Invest Ophthalmol Vis Sci 35:3789–3791PubMed
3.
go back to reference Kawase K, Matsushita H, Yamamoto T, Kitazawa Y (1992) Mitomycin concentration in rabbit and human ocular tissues after topical administration. Ophthalmology 99:203–207PubMed Kawase K, Matsushita H, Yamamoto T, Kitazawa Y (1992) Mitomycin concentration in rabbit and human ocular tissues after topical administration. Ophthalmology 99:203–207PubMed
4.
go back to reference Beckers HJ, Kinders KC, Webers CA (2003) Five-year results of trabeculectomy with mitomycin C. Graefes Arch Clin Exp Ophthalmol 241:106–110PubMedCrossRef Beckers HJ, Kinders KC, Webers CA (2003) Five-year results of trabeculectomy with mitomycin C. Graefes Arch Clin Exp Ophthalmol 241:106–110PubMedCrossRef
5.
go back to reference Anand N, Arora S, Clowes M (2006) Mitomycin C augmented glaucoma surgery: evolution of filtering bleb avascularity, transconjunctival oozing, and leaks. Br J Ophthalmol 90:175–180PubMedCrossRef Anand N, Arora S, Clowes M (2006) Mitomycin C augmented glaucoma surgery: evolution of filtering bleb avascularity, transconjunctival oozing, and leaks. Br J Ophthalmol 90:175–180PubMedCrossRef
6.
go back to reference Jermak CM, Dellacroce JT, Heffez J, Peyman GA (2007) Triamcinolone acetonide in ocular therapeutics. Surv Ophthalmol 52:503–522PubMedCrossRef Jermak CM, Dellacroce JT, Heffez J, Peyman GA (2007) Triamcinolone acetonide in ocular therapeutics. Surv Ophthalmol 52:503–522PubMedCrossRef
7.
go back to reference Nguyen KD, Lee DA (1992) Effect of steroids and nonsteroidal antiinflammatory agents on human ocular fibroblast. Invest Ophthalmol Vis Sci 33:2693–2701PubMed Nguyen KD, Lee DA (1992) Effect of steroids and nonsteroidal antiinflammatory agents on human ocular fibroblast. Invest Ophthalmol Vis Sci 33:2693–2701PubMed
8.
go back to reference Sun R, Gimbel HV, Kaye GB (1999) Photorefractive keratectomy in keratoconus suspects. J Cataract Refract Surg 25:1461–1466PubMedCrossRef Sun R, Gimbel HV, Kaye GB (1999) Photorefractive keratectomy in keratoconus suspects. J Cataract Refract Surg 25:1461–1466PubMedCrossRef
9.
go back to reference McGuigan LJ, Cook DJ, Yablonski ME (1986) Dexamethasone, D-penicillamine, and glaucoma filter surgery in rabbits. Invest Ophthalmol Vis Sci 27:1755–1757PubMed McGuigan LJ, Cook DJ, Yablonski ME (1986) Dexamethasone, D-penicillamine, and glaucoma filter surgery in rabbits. Invest Ophthalmol Vis Sci 27:1755–1757PubMed
10.
go back to reference Kalina PH, Erie JC, Rosenbaum L (1995) Biochemical quantification of triamcinolone in subconjunctival depots. Arch Ophthalmol 113:867–869PubMedCrossRef Kalina PH, Erie JC, Rosenbaum L (1995) Biochemical quantification of triamcinolone in subconjunctival depots. Arch Ophthalmol 113:867–869PubMedCrossRef
11.
go back to reference Jonas JB (2004) Intraocular availability of triamcinolone acetonide after intravitreal injection. Am J Ophthalmol 137:560–562PubMedCrossRef Jonas JB (2004) Intraocular availability of triamcinolone acetonide after intravitreal injection. Am J Ophthalmol 137:560–562PubMedCrossRef
12.
go back to reference Jones E, Clarke J, Khaw PT (2005) Recent advances in trabeculectomy technique. Curr Opin Ophthalmol 16:107–113PubMedCrossRef Jones E, Clarke J, Khaw PT (2005) Recent advances in trabeculectomy technique. Curr Opin Ophthalmol 16:107–113PubMedCrossRef
13.
go back to reference Wells AP, Bunce C, Khaw PT (2004) Flap and suture manipulation after trabeculectomy with adjustable sutures: titration of flow and intraocular pressure in guarded filtration surgery. J Glaucoma 13:400–416PubMedCrossRef Wells AP, Bunce C, Khaw PT (2004) Flap and suture manipulation after trabeculectomy with adjustable sutures: titration of flow and intraocular pressure in guarded filtration surgery. J Glaucoma 13:400–416PubMedCrossRef
14.
go back to reference Hogewind BF, Zijlstra C, Klevering BJ, Hoyng CB (2008) Intravitreal triamcinolone for the treatment of refractory macular edema in idiopathic intermediate or posterior uveitis. Eur J Ophthalmol 18:429–434PubMed Hogewind BF, Zijlstra C, Klevering BJ, Hoyng CB (2008) Intravitreal triamcinolone for the treatment of refractory macular edema in idiopathic intermediate or posterior uveitis. Eur J Ophthalmol 18:429–434PubMed
15.
go back to reference The AGIS Investigators (2000) The advanced glaucoma intervention study (AGIS): 7. the relationship between control of intraocular pressure and visual field deterioration. Am J Ophthalmol 130:429–440CrossRef The AGIS Investigators (2000) The advanced glaucoma intervention study (AGIS): 7. the relationship between control of intraocular pressure and visual field deterioration. Am J Ophthalmol 130:429–440CrossRef
16.
go back to reference European Glaucoma Society (2008) Terminology and guidelines for glaucoma, 3rd edn. Dogma, Savona, p 61 European Glaucoma Society (2008) Terminology and guidelines for glaucoma, 3rd edn. Dogma, Savona, p 61
17.
go back to reference Jampel HD, Musch DC, Gillespie BW, Lichter PR, Wright MM, Guire KE (2005) Perioperative complications of trabeculectomy in the Collaborative Initial Glaucoma Treatment Study (CIGTS). Am J Ophthalmol 140:16–22PubMedCrossRef Jampel HD, Musch DC, Gillespie BW, Lichter PR, Wright MM, Guire KE (2005) Perioperative complications of trabeculectomy in the Collaborative Initial Glaucoma Treatment Study (CIGTS). Am J Ophthalmol 140:16–22PubMedCrossRef
18.
go back to reference Jampel HD (1992) Effect of brief exposure to mitomycin C on viability and proliferation of cultured human Tenon’s capsule fibroblasts. Ophthalmology 99:1471–1476PubMed Jampel HD (1992) Effect of brief exposure to mitomycin C on viability and proliferation of cultured human Tenon’s capsule fibroblasts. Ophthalmology 99:1471–1476PubMed
19.
go back to reference Chen CW (1983) Enhanced intraocular pressure controlling effectiveness of trabeculectomy by local application of mitomycin C. Trans Asia Pac Acad Ophthalmol 9:172–176 Chen CW (1983) Enhanced intraocular pressure controlling effectiveness of trabeculectomy by local application of mitomycin C. Trans Asia Pac Acad Ophthalmol 9:172–176
20.
go back to reference Majmudar PA, Forstot SL, Dennis RF, Nirankari VS, Damiano RE, Brenart R, Epstein RJ (2000) Topical Mitomycin-C for subepithelial fibrosis after refractive corneal surgery. Ophthalmology 107:89–94PubMedCrossRef Majmudar PA, Forstot SL, Dennis RF, Nirankari VS, Damiano RE, Brenart R, Epstein RJ (2000) Topical Mitomycin-C for subepithelial fibrosis after refractive corneal surgery. Ophthalmology 107:89–94PubMedCrossRef
21.
go back to reference Giangiacomo J, Dueker DK, Adelstein E (1986) The effect of preoperative subconjunctival triamcinolone administration on glaucoma filtration. I. Trabeculectomy following subconjunctival triamcinolone. Arch Ophthalmol 104:838–841PubMedCrossRef Giangiacomo J, Dueker DK, Adelstein E (1986) The effect of preoperative subconjunctival triamcinolone administration on glaucoma filtration. I. Trabeculectomy following subconjunctival triamcinolone. Arch Ophthalmol 104:838–841PubMedCrossRef
22.
go back to reference Breusegem C, Spielberg L, Van Ginderdeuren R, Vandewalle E, Renier C, Van de Veire S, Fieuws S, Zeyen T, Stalmans I (2010) Preoperative nonsteroidal anti-inflammatory drug or steroid and outcomes after trabeculectomy: a randomized controlled trial. Ophthalmology 117:1324–1330PubMedCrossRef Breusegem C, Spielberg L, Van Ginderdeuren R, Vandewalle E, Renier C, Van de Veire S, Fieuws S, Zeyen T, Stalmans I (2010) Preoperative nonsteroidal anti-inflammatory drug or steroid and outcomes after trabeculectomy: a randomized controlled trial. Ophthalmology 117:1324–1330PubMedCrossRef
23.
go back to reference Tham CC, Li FC, Leung DY, Kwong YY, Yick DW, Chi CC, Lam DS (2006) Intrableb triamcinolone acetonide injection after bleb-forming filtration surgery (trabeculectomy, phacotrabeculectomy, and trabeculectomy revision by needling): a pilot study. Eye 20:1484–1486PubMedCrossRef Tham CC, Li FC, Leung DY, Kwong YY, Yick DW, Chi CC, Lam DS (2006) Intrableb triamcinolone acetonide injection after bleb-forming filtration surgery (trabeculectomy, phacotrabeculectomy, and trabeculectomy revision by needling): a pilot study. Eye 20:1484–1486PubMedCrossRef
24.
go back to reference Yuki K, Shiba D, Kimura I, Ohtake Y, Tsubota K (2009) Trabeculectomy with or without intraoperative sub-tenon injection of triamcinolone acetonide in treating secondary glaucoma. Am J Ophthalmol 147:1055–1060PubMedCrossRef Yuki K, Shiba D, Kimura I, Ohtake Y, Tsubota K (2009) Trabeculectomy with or without intraoperative sub-tenon injection of triamcinolone acetonide in treating secondary glaucoma. Am J Ophthalmol 147:1055–1060PubMedCrossRef
25.
go back to reference Maia M, Farah ME, Belfort RN, Penha FM, Lima Filho AA, Aggio FB, Belfort R Jr (2007) Effects of intravitreal triamcinolone acetonide injection with and without preservative. Br J Ophthalmol 91:1122–1124PubMedCrossRef Maia M, Farah ME, Belfort RN, Penha FM, Lima Filho AA, Aggio FB, Belfort R Jr (2007) Effects of intravitreal triamcinolone acetonide injection with and without preservative. Br J Ophthalmol 91:1122–1124PubMedCrossRef
26.
go back to reference Morrison VL, Koh HJ, Cheng L, Bessho K, Davidson MC, Freeman WR (2006) Intravitreal toxicity of the kenalog vehicle (benzyl alcohol) in rabbits. Retina 26:339–344PubMedCrossRef Morrison VL, Koh HJ, Cheng L, Bessho K, Davidson MC, Freeman WR (2006) Intravitreal toxicity of the kenalog vehicle (benzyl alcohol) in rabbits. Retina 26:339–344PubMedCrossRef
27.
go back to reference Thompson JT (2006) Cataract formation and other complications of intravitreal triamcinolone for macular edema. Am J Ophthalmol 141:629–637PubMedCrossRef Thompson JT (2006) Cataract formation and other complications of intravitreal triamcinolone for macular edema. Am J Ophthalmol 141:629–637PubMedCrossRef
28.
go back to reference Stalmans I, Gillis A, Lafaut AS, Zeyen T (2006) Safe trabeculectomy technique: long-term outcome. Br J Ophthalmol 90:44–47PubMedCrossRef Stalmans I, Gillis A, Lafaut AS, Zeyen T (2006) Safe trabeculectomy technique: long-term outcome. Br J Ophthalmol 90:44–47PubMedCrossRef
Metadata
Title
Purified triamcinolone acetonide as antifibrotic adjunct in glaucoma filtering surgery
Authors
Barend Frits Theodorus Hogewind
Benjamin Pijl
Carel Benedict Hoyng
Thomas Theelen
Publication date
01-04-2013
Publisher
Springer-Verlag
Published in
Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 4/2013
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI
https://doi.org/10.1007/s00417-012-2161-y

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