Stab incision mitomycin C‑assisted rapid trabeculectomy: A ‘SMART’ trabeculectomy alternative

Terzidou,Chryssa; Trivli,Alexandra; Dalianis,Georgios

doi:10.3892/etm.2020.8852

Stab incision mitomycin C‑assisted rapid trabeculectomy: A ‘SMART’ trabeculectomy alternative

Authors:
- Chryssa Terzidou
- Alexandra Trivli
- Georgios Dalianis
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Affiliations: Department of Ophthalmology, Konstantopouleio‑Patission General Hospital, Athens 14233, Greece
Published online on: June 10, 2020 https://doi.org/10.3892/etm.2020.8852
Pages: 1752-1757

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Abstract

The aim of the present study was to introduce a new modified trabeculectomy technique, stab incision mitomycin C (MMC)‑assisted rapid trabeculectomy (SMART), which requires less surgical time and tissue manipulation. A total of 41 eyes with indication for trabeculectomy underwent glaucoma surgery with the SMART technique; superior subconjunctival injection of 0.005 mg MMC mixed with 0.1 ml lidocaine, followed by small, fornix base conjunctival opening. A stab incision was made to enter the anterior chamber 1.5 mm post‑limbus using a 2.4 mm cataract knife. Double 0.75 mm punch and peripheral iridectomy were performed. A releasable suture was placed in the scleral opening, and matrix sutures to close conjunctiva. The preoperative mean intraocular pressure (IOP) was 23.8 mmHg, with a mean number of medications of 3.3. The mean follow‑up duration was 27.6 months, with a range of 12‑46 months. A year post‑surgery, the mean IOP was 11 mmHg, with a mean number of medications of 0.7, corresponding to a reduction of 12.8 mmHg in IOP and 2.6 in the number of medications. During follow‑up, additional 5‑fluorouracil injections were administered when needed. In conclusion, SMART with wound modulation appears to be a safe and quick alternative to classic trabeculectomy. Few minor and no major complications were observed during the first 2.5 years of follow‑up, with all eyes maintaining an IOP <15 mmHg.

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