Efficacy and tolerability of nonpenetrating glaucoma surgery augmented with mitomycin C in treatment of open-angle glaucoma: a meta-analysis

Objective: To evaluate the efficacy and tolerability of nonpenetrating glaucoma surgery (NPGS) augmented with mitomycin C (MMC) compared with trabeculectomy (TE) plus MMC in the treatment of patients with open-angle glaucoma. Design: Systematic review and meta-analysis. Participants: Eight clinical trials, including 4 cohort and 4 randomized, enrolled 459 eyes. Methods: Pertinent studies were selected through extensive searches of the Cochrane Library, MEDLINE, EMBASE, and meeting abstracts. Efficacy measures were weighted mean differences (WMDs) for the percentage intraocular pressure (IOP) reduction and relative risks (RRs) for success rates. Tolerability measures were RRs for adverse events. Pooled estimates were carried out in RevMan software v. 4.2. Results: NPGS augmented with MMC was associated with a numerically smaller but nonsignificant percentage reduction in IOP compared with TE plus MMC,with a WMD of-1.27% (95% CI-5.61 to 3.07) at 1 year, -4.55% (-10.35 to 1.24) at 2 years, -0.82% (-8.80 to 7.17) at 3 years, and -6.16% (-25.97 to 13.65) at 4 years. Significantly greater proportions of TE plus MMC patients than NPGS augmented with MMC patients achieved the target IOP without antiglaucoma medication at the end point, with a pooled RR of 0.74 (0.63-0.86). NPGS augmented with MMC was associated with a significantly lower frequency of shallow anterior chamber and cataract than TE plus M MC, with pooled RRs of 0.31 (0.16-0.60) and 0.23 (0.11-0.47), respectively. Conclusions: NPGS augmented with MMC was associated with IOP-lowering efficacy comparable to that of TE plus MMC. However, significantly fewer patients achieved the target IOP with NPGS augmented with MMC than with TE plus MMC. NPGS augmented with MMC was better tolerated than TE plus MMC.