Injected versus sponge-applied mitomycin C (MMC) during modified trabeculectomy in New Zealand white rabbit model

John Swogger, Ian P. Conner, Maranda Rosano, Megan Kemmerer, Carrie Happ-Smith, Alan Wells, Joel S. Schuman, Cecelia C. Yates

    Research output: Contribution to journalArticlepeer-review


    Purpose: Mitomycin C is routinely applied during trabeculectomy surgeries to enhance bleb survival after glaucoma filtration surgery. The current approach involves placing cellulose sponges soaked in mitomycin C at a standard concentration onto bare sclera for a predetermined duration, which varies among surgeons. The purpose of this study was to compare the effects of sponge-applied versus intra-Tenon injection of mitomycin C during modified trabeculectomy. Methods: Two groups of five New Zealand White rabbits underwent glaucoma filtration surgery with either preoperative intra-Tenon injection of mitomycin C or intraoperative application of mitomycin C using a cellulose sponge. Postoperative intraocular pressure was recorded weekly, and eyes were enucleated and sent for pathological examination and histological analysis. Results: An intra-Tenon injection of mitomycin C resulted in decreased intraocular pressure measurements and bleb vascularity compared to the controls but increased levels compared to the sponge-applied group. Collagen deposition and cellularity were reduced and the goblet cell population was increased in the intra-Tenon injection group. Conclusions: This study shows that an intra-Tenon injection can be an effective method for administering mitomycin C compared to the standard-of-care approach of mitomycin C being sponge applied onto bare sclera. Mitomycin C injection led to a greater reduction in intraocular pressure and inhibition of fibroblasts. The associated goblet cell population that can lead to increased mitomycin C toxicity-related morbidity was minimized with the intra-Tenon injection compared to the sponge-applied MMC treatment. Therefore, patients with ocular surface disease may benefit from an intraTenon injection. Translational Relevance: This project provides a direct, qualitative assessment in an animal model of common techniques within glaucoma filtration surgery for drug delivery to improve surgical success.

    Original languageEnglish (US)
    Article number23
    Pages (from-to)1-9
    Number of pages9
    JournalTranslational Vision Science and Technology
    Issue number11
    StatePublished - Oct 2020


    • Glaucoma
    • Mitomycin C
    • New Zealand White rabbit model
    • Scar formation
    • Trabeculectomy

    ASJC Scopus subject areas

    • Biomedical Engineering
    • Ophthalmology


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