Mytomycin C versus 5-Fluorouracil for Trabeculectomy: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

1. Department of Eye, the First Hospital, Xinjiang Medical University, Urumqi 830054, China 2. Evidence-Based Medicien Center, The First Hospital, Xinjiang Medical University, Urumqi 830054, China;

Corresponding author：

Keywords：

Mytomycin C; 5-Fluorouracil; Trabeculectomy; Glaucoma; Randomized controlled trial; Systematic review

DOI：

10.7507/1672-2531.20100484

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Objective 　 To assess the efficacy and safety of mytomycin C versus 5-fluorouracil for trabeculectomy.
Methods 　We electronically searched the Cochrane Central Register of Controlled Trials (Issue 3, 2008), MEDLINE (1966 to October 2008), EMbase (1947 to October 2008), CMBdisk (1979 to October 2008).We also handsearched relevant conference proceedings. Data were extracted by two reviewers independently using an extraction form. The Cochrane Collaboration’ s RevMan 5.0 software was used for statistical analyses.
Results 　Nine randomized controlled trials (RCTs) involving 482 participants (495eyes) were identified. The trials enrolled three types of participants (high risk of failure, moderate risk of failure, low risk of failure). As for high risk of failure, compared with mytomycin C, 5-fluorouracil appeared to increase the rate of postoperative complications (RR –5.74, 95%CI –9.91, –1.58). No significant differences were found in postoperative mean intraocular pressure(IOP) (WMD –?2.31, 95%CI –?7.34, 2.71), success rate (RR 1.13, 95%CI 0.91, 1.39) and visual acuity ≥3-line decrease (RR 1.46, 95%CI 0.43, 4.94). As for low risk of failure, there were no significant differences in success rate (RR 1.10, 95%CI 0.99, 1.22) and postoperative complications (RR 1.00, 95%CI –6.21, 8.21).
Conclusion 　In both groups of high risk and low risk of failure, there are no significant differences in postoperative mean IOP and success rate. However, in the group of high risk of failure, compared with 5-fluorouracil, mytomycin C appears to raise the rate of postoperative complications; the rate of reducing the eyes pressure cannot be concluded based on current evidence. However, as the number of the studied cases is rather small and the period of observation is also limited, long-term follow-up of multi-central RCTs with a larger number of cases are still needed before definite conclusions can be made. Further studies are also needed to better determine the pharmacokinetics and cost-effective analyses involving the use of the two agents for glaucoma filtering surgery.

Citation： MinavarAbdu,CHEN Xueyi,JuretKadir,AkramArkin. Mytomycin C versus 5-Fluorouracil for Trabeculectomy: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2010, 10(6): 730-739. doi: 10.7507/1672-2531.20100484 Copy

1.	Morrison JC. Glaucoma science and practice. Thieme New York.Stuttgart 2003, epidemiology of glaucoma: 2 Filtration surgery: 463-464.
2.	SK Law, T Li. Acupuncture for glaucoma. Cochrane Database Syst Rev, 2007, 17(4): CD006030.
3.	Rossetti L, Marchetti I, Orzalesi N, et al. Randomized clinical trials on medical treatment of glaucoma. Are they appropriate to guide clinical practice? Arch Ophthal, 1993, 111(1): 96-103.
4.	de Moura CR, Paranhos A, Wormald R. Laser trabeculoplasty for open angle glaucoma. Cochrane Database Syst Rev, 2007, 17(4):CD003919.
5.	Cairns JE. Trabeculectomy. Preliminary report of a new method. Am J Ophthalmol, 1968, 66(4): 673-679.
6.	Kanski JJ. Clinical ophthalmology, Edinburgh. Butterworth-Heinemann, 2003.Gluacoma: 259-260.
7.	Wilkins M, Indar A, Wormald R. Intra-operative Mitomycin C for glaucoma surgery. Cochrane Database of Systematic Reviews 19 October 2005 in Issue 4. Art. No.: CD002897. DOI:10.1002/14651858.CD002897.pub2.
8.	Wu DD, Cantor LB, Palanca-Capistrano AM, et al. A prospective randomized trial comparing intraoperative 5-fluorouracil vs mitomycin C in primary trabeculectomy. Am J Ophthalmol, 2002, 134(4): 521-528.
9.	Katz GJ, Higginbotham EJ, Lichter PR, et al. Mitomycin C versus 5-fluorouracil in high-risk glaucoma filtering surgery. Extended follow-up. Ophthalmology, 1995, 102(9): 1263-1269.
10.	吴泰相, 刘关键. 隐蔽分组(分配隐藏)和盲法的概念、实施与报告. 中国循证医学杂志, 2007, 7(3): 222-225.
11.	Singh K, Egbert PR, Byrd S, et al. Trabeculectomy with intraoperative 5-fluorouracil vs mitomycin C. Am J Ophthalmol, 1997, 123(1): 48-53.
12.	Singh K, Mehta K, Shaikh NM, et al. Trabeculectomy with intraoperative mitomycin C versus 5-fluorouracil. Prospective randomized clinical trial. Ophthalmology, 2000, 107(12): 2305-2309.
13.	Sisto D, Vetrugno M, Trabucco T, et al. The role of antimetabolites in filtration surgery for neovascular glaucoma: intermediate-term follow-up. Acta Ophthalmol Scand, 2007, 85(3): 267-271.
14.	Palanca-Capistrano AM, Hall J, Cantor LB, et al. Long-term Outcomes of Intraoperative 5-Fluorouracil versus Intraoperative Mitomycin C in Primary Trabeculectomy Surgery. Ophthalmology, 2009, 116(2): 185-190.
15.	Lamping KA, Belkin JK. 5-Fluorouracil and mitomycin C in pseudophakic patients. Ophthalmology, 1995, 102(1): 70-75.
16.	Skuta GL, Beeson CC, Higginbotham EJ, et al. Intraoperative mitomycin versus postoperative 5-fluorouracil in high-risk glaucoma filtering surgery. Ophthalmology, 1992, 99(3): 438-444.
17.	Kitazawa Y, Kawase K, Matsushita H, et al. Trabeculectomy with mitomycin. A comparative study with fluorouracil. Arch Ophthalmol, 1991, 109(12): 1693-1698.
18.	Capistrano AP, WuDunn D, Cantor LB. Comparison of IOP control when using intraoperative 5-fluorouracil versus mitomycin C at six and twelve months in primary trabeculectomy, IOVS. Volume 42ARVO Abstract 2971, 2001.
19.	Barton K, Franks WA, Vunce C. Long-term outcome of MMC vs 5-Fu trabeculectomy in uveitic glaucoma, IOVS. Volume 45ARVO E-abstract 991, 2004.
20.	Barton K, Franks WA, Pavesio CE. A prospective comparison of intraoperative 5-fluorouracil versus mitomycin C trabeculectomy in uveitic glaucoma, IOVS. Volume 42ARVO Abstract 580, 2001.
21.	Vijaya L, Mukhesh BN, Shantha B, et al. Comparison of low-dose intraoperative mitomycin-C vs 5-fluorouracil in primary glaucoma surgery: a pilot study. Ophthalmic Surg Lasers, 2000, 31(1): 24-30.
22.	Robin AL, Ramakrishnan R, Krishnadas R, et al. A long-term dose-response study of mitomycin in glaucoma filtration surgery. Arch Ophthalmol, 1997, 115(8): 969-974.
23.	李美玉. 主编. 青光眼学. 北京: 人民卫生出版社, 2004: 前言, 589.

1. Morrison JC. Glaucoma science and practice. Thieme New York.Stuttgart 2003, epidemiology of glaucoma: 2 Filtration surgery: 463-464.
2. SK Law, T Li. Acupuncture for glaucoma. Cochrane Database Syst Rev, 2007, 17(4): CD006030.
3. Rossetti L, Marchetti I, Orzalesi N, et al. Randomized clinical trials on medical treatment of glaucoma. Are they appropriate to guide clinical practice? Arch Ophthal, 1993, 111(1): 96-103.
4. de Moura CR, Paranhos A, Wormald R. Laser trabeculoplasty for open angle glaucoma. Cochrane Database Syst Rev, 2007, 17(4):CD003919.
5. Cairns JE. Trabeculectomy. Preliminary report of a new method. Am J Ophthalmol, 1968, 66(4): 673-679.
6. Kanski JJ. Clinical ophthalmology, Edinburgh. Butterworth-Heinemann, 2003.Gluacoma: 259-260.
7. Wilkins M, Indar A, Wormald R. Intra-operative Mitomycin C for glaucoma surgery. Cochrane Database of Systematic Reviews 19 October 2005 in Issue 4. Art. No.: CD002897. DOI:10.1002/14651858.CD002897.pub2.
8. Wu DD, Cantor LB, Palanca-Capistrano AM, et al. A prospective randomized trial comparing intraoperative 5-fluorouracil vs mitomycin C in primary trabeculectomy. Am J Ophthalmol, 2002, 134(4): 521-528.
9. Katz GJ, Higginbotham EJ, Lichter PR, et al. Mitomycin C versus 5-fluorouracil in high-risk glaucoma filtering surgery. Extended follow-up. Ophthalmology, 1995, 102(9): 1263-1269.
10. 吴泰相, 刘关键. 隐蔽分组(分配隐藏)和盲法的概念、实施与报告. 中国循证医学杂志, 2007, 7(3): 222-225.
11. Singh K, Egbert PR, Byrd S, et al. Trabeculectomy with intraoperative 5-fluorouracil vs mitomycin C. Am J Ophthalmol, 1997, 123(1): 48-53.
12. Singh K, Mehta K, Shaikh NM, et al. Trabeculectomy with intraoperative mitomycin C versus 5-fluorouracil. Prospective randomized clinical trial. Ophthalmology, 2000, 107(12): 2305-2309.
13. Sisto D, Vetrugno M, Trabucco T, et al. The role of antimetabolites in filtration surgery for neovascular glaucoma: intermediate-term follow-up. Acta Ophthalmol Scand, 2007, 85(3): 267-271.
14. Palanca-Capistrano AM, Hall J, Cantor LB, et al. Long-term Outcomes of Intraoperative 5-Fluorouracil versus Intraoperative Mitomycin C in Primary Trabeculectomy Surgery. Ophthalmology, 2009, 116(2): 185-190.
15. Lamping KA, Belkin JK. 5-Fluorouracil and mitomycin C in pseudophakic patients. Ophthalmology, 1995, 102(1): 70-75.
16. Skuta GL, Beeson CC, Higginbotham EJ, et al. Intraoperative mitomycin versus postoperative 5-fluorouracil in high-risk glaucoma filtering surgery. Ophthalmology, 1992, 99(3): 438-444.
17. Kitazawa Y, Kawase K, Matsushita H, et al. Trabeculectomy with mitomycin. A comparative study with fluorouracil. Arch Ophthalmol, 1991, 109(12): 1693-1698.
18. Capistrano AP, WuDunn D, Cantor LB. Comparison of IOP control when using intraoperative 5-fluorouracil versus mitomycin C at six and twelve months in primary trabeculectomy, IOVS. Volume 42ARVO Abstract 2971, 2001.
19. Barton K, Franks WA, Vunce C. Long-term outcome of MMC vs 5-Fu trabeculectomy in uveitic glaucoma, IOVS. Volume 45ARVO E-abstract 991, 2004.
20. Barton K, Franks WA, Pavesio CE. A prospective comparison of intraoperative 5-fluorouracil versus mitomycin C trabeculectomy in uveitic glaucoma, IOVS. Volume 42ARVO Abstract 580, 2001.
21. Vijaya L, Mukhesh BN, Shantha B, et al. Comparison of low-dose intraoperative mitomycin-C vs 5-fluorouracil in primary glaucoma surgery: a pilot study. Ophthalmic Surg Lasers, 2000, 31(1): 24-30.
22. Robin AL, Ramakrishnan R, Krishnadas R, et al. A long-term dose-response study of mitomycin in glaucoma filtration surgery. Arch Ophthalmol, 1997, 115(8): 969-974.
23. 李美玉. 主编. 青光眼学. 北京: 人民卫生出版社, 2004: 前言, 589.

Chinese Journal of Evidence-Based Medicine

Mytomycin C versus 5-Fluorouracil for Trabeculectomy: A Systematic Review

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