Topical Mitomycin-C versus Subconjunctival 5-Fluorouracil for Management of Bleb Failure

Purpose: to compare the efficacy and safety of topical mitomycin-c (mmc) drops with that of subconjunctival 5-fluorouracil (5-fu) injections for management of early bleb failure after trabeculectomy or combined phacoemulsification and trabeculectomy with posterior chamber intraocular lens implantation (pt+pciol). methods: in a randomized comparative study, 37 eyes of 37 patients with impending early bleb failure received mmc 0.02% eye drops for 2 or 4 weeks (19 eyes) orsubconjunctival 5-fu injections, 5 mg per dose (18 eyes). complete success was defined as 5 < iop ≤ 18 mmhg without medications. results: baseline characteristics were comparable between the study groups. however, there were more cases of combined pt+pciol in the mmc group [11 (57.9%) eyesversus 3 (16.7%) eyes, p = 0.017]. mean preoperative iop was 20.5±8.85 mmhg in the mmc group and 25.82±11.35 mmhg in the 5-fu group (p = 0.129), which was decreased to 13.2±6.1 and 10.6±4.8 mmhg respectively after 12 months (p = 0.159). there was no significant difference between the study groups in terms of bleb extent (p = 0.170), height (p = 0.178) or vascularity (p = 0.366). at the end of the study, complete success was achieved in 13 eyes (68.4%) in the mmc group and 14 eyes (77.8%) in the 5-fu group (p = 0.714). the survival of success at 8 months (median follow-up) was 89.5% and 86.5% in the mmc and 5-fu groups respectively; the number of glaucoma medications (p = 0.707) and best-corrected visual acuity (p = 0.550) were also comparable. complication rates were similar in the study groups (p = 0.140). conclusion: topical mmc 0.02% has comparable safety and efficacy to subconjunctival 5-fu injections for management of early bleb failure. topical mmc 0.02% drops aremore convenient and can be initiated first, while 5-fu injections may be reserved for eyes with an insufficient response to topical mmc.