Mitomycin C After AGV Implantation in Refractory Glaucoma
Ahmed glaucoma valve (AGV) implantation has been widely used and has been proved to be an effective method for treating refractory glaucoma. Several studies in the literature have reported success rates of AGV implantation ranging from 49% to 83.6%. Encapsulated cyst formation is one of the main reasons for failure. The proliferation of fibrous tissue around the implant plates blocks the diffusion of aqueous humor and elevates intraocular pressure (IOP). Adjunctive use of antimetabolites can greatly inhibit fibrosis, and mitomycin C (MMC) has been used extensively in filtering and glaucoma drainage device implant surgery. However, how to use MMC more effective has remained to be explored further. Heuer et al.. Found that double-plate Molteno implantation more frequently affords IOP control than single-plate Molteno. Assuming that the expanded surface area of the implant plate allows reduced occurrence of encapsulated cyst, it is also supposed that expanding the MMC function area in the scleral bed where the AGV is placed may decrease encapsulated cyst formation. Unfortunately, the cotton soaked with MMC and inserted into the implantation area often rolls into a mass, without a guarantee of enough size. Therefore, we improved the method by introducing a novel way for MMC to be used: the valve plate was first encompassed with a thin layer of cotton soaked with MMC, then insert into the implanted area. In this study, we evaluated its surgical outcomes to see whether the new method could produce better surgical results.
Background
Ahmed glaucoma valve (AGV) implantation has been widely used and has been proved to be an effective method for treating refractory glaucoma. Several studies in the literature have reported success rates of AGV implantation ranging from 49% to 83.6%. Encapsulated cyst formation is one of the main reasons for failure. The proliferation of fibrous tissue around the implant plates blocks the diffusion of aqueous humor and elevates intraocular pressure (IOP). Adjunctive use of antimetabolites can greatly inhibit fibrosis, and mitomycin C (MMC) has been used extensively in filtering and glaucoma drainage device implant surgery. However, how to use MMC more effective has remained to be explored further. Heuer et al.. Found that double-plate Molteno implantation more frequently affords IOP control than single-plate Molteno. Assuming that the expanded surface area of the implant plate allows reduced occurrence of encapsulated cyst, it is also supposed that expanding the MMC function area in the scleral bed where the AGV is placed may decrease encapsulated cyst formation. Unfortunately, the cotton soaked with MMC and inserted into the implantation area often rolls into a mass, without a guarantee of enough size. Therefore, we improved the method by introducing a novel way for MMC to be used: the valve plate was first encompassed with a thin layer of cotton soaked with MMC, then insert into the implanted area. In this study, we evaluated its surgical outcomes to see whether the new method could produce better surgical results.
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