Posters

National survey of MMC use during intraoperative trabeculectomy surgery in the UK

Poster Details

First Author: S.Ahmed Khan UK

Co Author(s): K. Whittaker                    

Abstract Details

Purpose:

Trabeculectomy is one of the most common and well recognized surgical procedure to treat glaucoma by effectively reducing the intraocular pressure. Mitomycin C is a routinely used anti-metabolite effective in limiting the scarring process and is used in varying concentrations ranging from 0.01 to 0.5 mg/ml. Chen in 1983 described the adjunct use of MMC in trabeculectomy surgery. Aim of this study is to evaluate the current practice of delivering MMC during trabeculectomy surgery and to see the practices related to a retained MMC swab during trabeculectomy in the UK.

Setting:

Electronic email survey of UKEGS society member ophthalmologists.

Methods:

An electronic questionnaire of 8 questions regarding MMC use in trabeculectomy surgery was sent to 69 ophthalmologist members of the UK and Eire glaucoma society (UKEGS) through email in July 2019. The survey was sent to the selected UKEGS member ophthalmologists, only who had chosen to be opted in for accepting the study surveys from the UKEGS administration. An online software “smart survey” was utilized for designing and distributing the survey and analyzing the results. Microsoft excel software was also utilized for data analysis.

Results:

The response rate was moderately good with 50.72% (35 out of 69) of the ophthalmologists surveyed returning the electronic questionnaire. 97.2% (34 out of 35) of the surveyed glaucoma surgeons said they use MMC during trabeculectomy surgery. 94.29% respondents said they use MMC for more than half of their cases.11.76% surgeons said they had a retained MMC soaked sponge during surgery. All respondents who had a retained MMC swab during surgery employed the same multiple individual sponges- technique. 47.1% surgeons said they use multiple individual sponges on being asked what technique they currently employ for delivering MMC during trabeculectomy.

Conclusions:

The intra-operative MMC use in the UK is high with almost all the surgeons preferring MMC during trabeculectomy. We recommend following measures to reduce the chance of a retained MMC swab which could result in serious complications 1. Having robust checks in place for MMC delivery during trabeculectomy including counting the number of swabs in and out & avoiding very small sized individual cut sponges. 2. Delivering the MMC in an injectable form during trabeculectomy rather than using sponges where it is suitable to do so. 3. Using the necklace sponge technique where multiple sponges are linked with the necklace suture.

Financial Disclosure:

None