Optimal Intra-operative Mitomycin C Dose improves success of Microshunt Implantation among Glaucoma Patients

A recent multicenter retrospective cohort study involved 250 eyes from 220 glaucoma patients and identified the factors influencing the success of Microshunt implantation. This study was designed to evaluate risk factors for Microshunt failure, and found the crucial elements that could enhance surgical outcomes for glaucoma patients. The findings were published in American Journal of Ophthalmology.

The success criteria were defined based on intraocular pressure (IOP) outcomes, ranging from a reduction to as low as 12mmHg. At the 1-year follow-up, success rates varied between 43.3% and 62.5%, depending on the specific criteria. Notably, the concentration of mitomycin-C (MMC) during surgery emerged as a key determinant. Higher intraoperative MMC concentration was associated with a significantly reduced risk of failure for both complete and overall success.

The study showed other risk factors contributing to Microshunt failure. Pseudoexfoliation glaucoma/pigmentary glaucoma, primary angle-closure glaucoma, and a history of non-glaucomatous ocular surgeries increased the risk of failure for complete success. For overall success, factors such as lower preoperative IOP, a higher number of preoperative antiglaucoma agents, and the combination of Microshunt with cataract surgery were identified as significant risk factors.

These findings underscore the need for precision in surgical approaches and highlight the intricate balance required for optimal outcomes. The study not only provides critical insights into factors influencing Microshunt efficacy but also emphasizes the importance of personalized patient selection for these procedures.

Advancements in glaucoma management continue to evolve and this research opens avenues for refining surgical strategies, offering hope for improved outcomes and quality of life for glaucoma patients. The identification of these risk factors is a crucial step towards enhancing the effectiveness of Microshunt procedures, bringing us closer to more tailored and successful glaucoma interventions.

Source:

Rabiolo, A., Toscani, R., Sacchi, M., Destefanis, P., Bettin, P., Ciampi, C., Clemente, A., Cutolo, C. A., Mercieca, K., Iester, M., Traverso, C. E., Maita, M. D., Calzi, G. L., Nucci, P., Bandello, F., Triolo, G., & De Cillà, S. (2023). Risk factors for failure in glaucoma patients undergoing microshunt implantantion. American Journal of Ophthalmology. https://doi.org/10.1016/j.ajo.2023.11.011