Skip to main content

Advertisement

SpringerLink
Log in

Purified triamcinolone acetonide as antifibrotic adjunct in glaucoma filtering surgery

  • Glaucoma
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Wilkins M, Indar A, Wormald R (2005) Intra-operative mitomycin C for glaucoma surgery. Cochrane Database Syst Rev CD002897

  2. Lee DA (1994) Antifibrosis agents and glaucoma surgery. Invest Ophthalmol Vis Sci 35:3789–3791

    PubMed  CAS  Google Scholar 

  3. Kawase K, Matsushita H, Yamamoto T, Kitazawa Y (1992) Mitomycin concentration in rabbit and human ocular tissues after topical administration. Ophthalmology 99:203–207

    PubMed  CAS  Google Scholar 

  4. Beckers HJ, Kinders KC, Webers CA (2003) Five-year results of trabeculectomy with mitomycin C. Graefes Arch Clin Exp Ophthalmol 241:106–110

    Article  PubMed  CAS  Google Scholar 

  5. Anand N, Arora S, Clowes M (2006) Mitomycin C augmented glaucoma surgery: evolution of filtering bleb avascularity, transconjunctival oozing, and leaks. Br J Ophthalmol 90:175–180

    Article  PubMed  CAS  Google Scholar 

  6. Jermak CM, Dellacroce JT, Heffez J, Peyman GA (2007) Triamcinolone acetonide in ocular therapeutics. Surv Ophthalmol 52:503–522

    Article  PubMed  CAS  Google Scholar 

  7. Nguyen KD, Lee DA (1992) Effect of steroids and nonsteroidal antiinflammatory agents on human ocular fibroblast. Invest Ophthalmol Vis Sci 33:2693–2701

    PubMed  CAS  Google Scholar 

  8. Sun R, Gimbel HV, Kaye GB (1999) Photorefractive keratectomy in keratoconus suspects. J Cataract Refract Surg 25:1461–1466

    Article  PubMed  CAS  Google Scholar 

  9. McGuigan LJ, Cook DJ, Yablonski ME (1986) Dexamethasone, D-penicillamine, and glaucoma filter surgery in rabbits. Invest Ophthalmol Vis Sci 27:1755–1757

    PubMed  CAS  Google Scholar 

  10. Kalina PH, Erie JC, Rosenbaum L (1995) Biochemical quantification of triamcinolone in subconjunctival depots. Arch Ophthalmol 113:867–869

    Article  PubMed  CAS  Google Scholar 

  11. Jonas JB (2004) Intraocular availability of triamcinolone acetonide after intravitreal injection. Am J Ophthalmol 137:560–562

    Article  PubMed  CAS  Google Scholar 

  12. Jones E, Clarke J, Khaw PT (2005) Recent advances in trabeculectomy technique. Curr Opin Ophthalmol 16:107–113

    Article  PubMed  Google Scholar 

  13. 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 13:400–416

    Article  PubMed  Google Scholar 

  14. 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 18:429–434

    PubMed  CAS  Google Scholar 

  15. 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 130:429–440

    Article  Google Scholar 

  16. European Glaucoma Society (2008) Terminology and guidelines for glaucoma, 3rd edn. Dogma, Savona, p 61

    Google Scholar 

  17. 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 140:16–22

    Article  PubMed  Google Scholar 

  18. Jampel HD (1992) Effect of brief exposure to mitomycin C on viability and proliferation of cultured human Tenon’s capsule fibroblasts. Ophthalmology 99:1471–1476

    PubMed  CAS  Google Scholar 

  19. Chen CW (1983) Enhanced intraocular pressure controlling effectiveness of trabeculectomy by local application of mitomycin C. Trans Asia Pac Acad Ophthalmol 9:172–176

    Google Scholar 

  20. 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 107:89–94

    Article  PubMed  CAS  Google Scholar 

  21. Giangiacomo J, Dueker DK, Adelstein E (1986) The effect of preoperative subconjunctival triamcinolone administration on glaucoma filtration. I. Trabeculectomy following subconjunctival triamcinolone. Arch Ophthalmol 104:838–841

    Article  PubMed  CAS  Google Scholar 

  22. 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 117:1324–1330

    Article  PubMed  Google Scholar 

  23. 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 20:1484–1486

    Article  PubMed  CAS  Google Scholar 

  24. 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 147:1055–1060

    Article  PubMed  CAS  Google Scholar 

  25. 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 91:1122–1124

    Article  PubMed  Google Scholar 

  26. Morrison VL, Koh HJ, Cheng L, Bessho K, Davidson MC, Freeman WR (2006) Intravitreal toxicity of the kenalog vehicle (benzyl alcohol) in rabbits. Retina 26:339–344

    Article  PubMed  Google Scholar 

  27. Thompson JT (2006) Cataract formation and other complications of intravitreal triamcinolone for macular edema. Am J Ophthalmol 141:629–637

    Article  PubMed  CAS  Google Scholar 

  28. Stalmans I, Gillis A, Lafaut AS, Zeyen T (2006) Safe trabeculectomy technique: long-term outcome. Br J Ophthalmol 90:44–47

    Article  PubMed  CAS  Google Scholar 

Download references

Affiliations of the authors and sources of support

Department of Ophthalmology, Medical Centre Haaglanden, The Hague, the Netherlands, and Department of Ophthalmology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands. There is no source of research support to acknowledge.

Conflict of interest

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Medical Centre Haaglanden, Lijnbaan 32, 2512 VA, The Hague, the Netherlands

    Barend Frits Theodorus Hogewind

  2. Department of Ophthalmology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands

    Benjamin Pijl, Carel Benedict Hoyng & Thomas Theelen

Authors
  1. Barend Frits Theodorus Hogewind
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Benjamin Pijl
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carel Benedict Hoyng
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thomas Theelen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Barend Frits Theodorus Hogewind.

Additional information

Primary data

Authors have full control of all primary data, and they agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review their data if requested.

Medical ethical considerations

The study was in accordance with the principles of the 1995 Declaration of Helsinki (as revised in Edinburgh 2000) and was approved by the regional medical ethics board (number 2008/337).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hogewind, B.F.T., Pijl, B., Hoyng, C.B. et al. Purified triamcinolone acetonide as antifibrotic adjunct in glaucoma filtering surgery. Graefes Arch Clin Exp Ophthalmol 251, 1213–1218 (2013). https://doi.org/10.1007/s00417-012-2161-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-012-2161-y

Keywords

Search

Navigation