Effect of mitomycin C on aqueous humor flow, flare and intraocular pressure in eyes with glaucoma 2 years after trabeculectomy

Background: The purpose of this study was to determine the intraocular pressure (IOP), aqueous humor flow, flare and ocular side effects in eyes with a history of hypotony after trabeculectomy with adjunctive mitomycin C (MMC). Methods: Thirty-six eyes with primary or secondary open-angle glaucoma and IOP less than or equal to 8 mmHg during the postoperative period were studied 745+/-315 days after surgery. MMC (0.2 or 0.5 mg/ml) was applied to the episclera with a cellular sponge. Flare was studied with the Kowa Laser Flare Meter 500. Aqueous humor flow was measured in the afternoon (Fluorotron Master II). IOP, visual fields and best corrected visual acuity were also examined. Twenty-two contralateral eyes without surgical intervention served as controls. Results: The mean age of patients was 44.5+/-16.8 years. The mean IOP was significantly lower in the MMC group than in the control group: 9.6+/-6.4 mmHg vs 18.0+/-13.6 mmHg at 2 years (P<0.001). Aqueous flow was significantly lower in subjects treated with MMC than in controls (P<0.001). The flare values were significantly higher in the MMC-treated group, with a mean of 12.0+/-7.7 photon counts/ms, than in the control group, mean 7.9+4.6 photon counts/ms (P<0.019). Conclusion: Our data suggest that MMC is a useful ocular hypotensive agent which seems to participate in a change in aqueous humor dynamics when applied topically as an aqueous solution.