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Arquivos Brasileiros de Oftalmologia 2014
Topics: Glaucoma Drainage Implants; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Mitomycin; Trabeculectomy
PubMed: 25295896
DOI: 10.5935/0004-2749.20140035 -
Medical Science Monitor : International... Jul 2011To evaluate the intraocular pressure (IOP)-lowering effects achieved by nonpenetrating glaucoma surgery (NPGS) and its modifications in patients with open angle glaucoma. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
To evaluate the intraocular pressure (IOP)-lowering effects achieved by nonpenetrating glaucoma surgery (NPGS) and its modifications in patients with open angle glaucoma.
MATERIAL/METHODS
Randomized controlled trials evaluating patients with primary and secondary open angle glaucoma treated with NPGS were identified through systematic searches. The main outcome measures were the percentage IOP reduction and the complete success rate. Complete success was defined as target endpoint IOP (usually less than 21 mm Hg) without medications. The pooled estimates were calculated using the random effects model.
RESULTS
Both deep sclerectomy (DS) and viscocanalostomy (VCO) were less effective than trabeculectomy (TE) in lowering IOP, with the percentage IOP reductions at 2 years being 35.2% for DS, 30.2% for VCO, and 45.6% for TE. Intraoperative use of implants and mitomycin C (MMC) increased IOP-lowering effects of DS, with IOP reductions at 2 years of 41.1% and 41.7%, respectively. The complete success rates at 4 years were 35.4% for DS, and 22.7% for VCO, lower than that of TE (47.6%). The complete success rates of DS with implants and MMC of 64.6% and 52.1%, respectively, at 4 years, were greater than that of primary DS. NPGS caused major complications in fewer patients than did TE.
CONCLUSIONS
Primary deep sclerectomy and primary viscocanalostomy, which can significantly lower IOP, were associated with fewer complications than was TE. However, the IOP-lowering effects of both NPGS seem to be lower than that of primary TE. The efficacy of DS can be improved with the intraoperative use of implants and MMC.
Topics: Filtering Surgery; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Mitomycin
PubMed: 21709645
DOI: 10.12659/msm.881840 -
Immunotherapy May 2010Major controversies still exist with regard to the indication, type and regimen of intravesical therapy for non-muscle-invasive bladder cancer. Other areas of... (Review)
Review
Major controversies still exist with regard to the indication, type and regimen of intravesical therapy for non-muscle-invasive bladder cancer. Other areas of controversy are the criteria for response/failure of treatment and for decisions regarding secondary intravesical therapy versus radical cystectomy. In this article, we analyze the different intravesical therapeutic strategies and compare their safety and efficacy. Well-designed clinical trials have found that the addition of bacillus Calmette-Guerin (BCG) to transurethral resection (TUR) decreases the risk for both disease recurrence and progression. These encouraging results are sustained even in patients with recurrent or aggressive disease, including patients whose prior intravesical chemotherapy has failed. Most investigators believe that the efficacy of BCG therapy can be maximized with maintenance therapy. Mitomycin C (MMC), the most commonly used intravesical chemotherapy to date, decreases the risk of disease recurrence but not disease progression when used after TUR compared with TUR alone. The oncologic efficacy of intravesical MMC can be optimized by increasing its concentration in addition to alkalinizing and reducing urine production. For patients at high risk of disease progression, BCG with maintenance therapy should be the preferred primary intravesical therapeutic strategy. However, MMC can be considered as a viable alternative for patients with papillary tumors (no carcinoma in situ) that are at low or intermediate risk of disease progression. Combination intravesical therapy may be more successful than single-agent strategies. Intravesical therapy failures indicate the need to include radical cystectomy as an option in the management decision.
Topics: Administration, Intravesical; Antineoplastic Agents; BCG Vaccine; Combined Modality Therapy; Cystectomy; Docetaxel; Humans; Mitomycin; Taxoids; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 20635902
DOI: 10.2217/imt.10.1 -
BMC Ophthalmology Mar 2023The aim of this study was to compare trabeculectomy outcomes in patients with and without post-operative serous choroidal detachment (CD) and establish an association...
BACKGROUND
The aim of this study was to compare trabeculectomy outcomes in patients with and without post-operative serous choroidal detachment (CD) and establish an association between CD and trabeculectomy outcomes.
METHODS
In this 4-year retrospective cohort study, medical records of glaucoma patients older than 18 who underwent primary trabeculectomy with Mitomycin-C between 2012 and 2020 were reviewed. Phakic eyes without history of any other intraocular surgery and with at least one year of follow-up were included in the study. Postoperative CD was defined as clinically visible CD developed within the first postoperative week. Cases were categorized into with and without CD and trabeculectomy outcomes were compared. Comparison was carried out using postoperative intraocular pressure (IOP), glaucoma medications and surgery success. Two levels of success were defined regardless of glaucoma medications; criteria A) 5 < IOP < 19 mmHg and criteria B) 5 < IOP < 16 mmHg. In addition to the defined IOP ranges, IOP reduction less than 20% from baseline and further glaucoma surgery were also counted as surgery failures.
RESULTS
Total of 183 patients including 153 without CD (mean age 58.73 ± 11.40 years, mean IOP 23.7 ± 6.63 mmHg) and 30 with CD (59.00 ± 12.59 years, mean IOP 22.2 ± 3.83 mmHg) entered the study. Post-trabeculectomy mean IOPs were significantly higher in the CD group at all follow-up visits at year 1 through 4 (14.70, and 14.82 mmHg vs. 11.03, and 12.59 mmHg; p-value < 0.05). Similarly mean number of glaucoma medications was higher in the CD group at all follow-up visits (p-value > 0.001). Based on success criteria A, cumulative probability of success for patients with CD wasn't significantly different compared to those without CD at years 1 through 4 (80.0%, and 69.6% vs. 88.2%, and 74.1% respectively; p-value > 0.05, log-rank). However, based on success criteria B, patients with CD had significantly lower cumulative probability of success at years 1 through 4 (50.0% and 8.9% vs. 79.7% and 59.8%, p-value < 0.001).
CONCLUSION
We established that early post-trabeculectomy serous choroidal detachment is associated with adverse surgery outcomes. Lower rate of surgery success and higher mean postoperative IOP and glaucoma medications were observed in patients with post-trabeculectomy choroidal detachment and this was more pronounced in patients who required more stringent IOP control (success definition 5 < IOP < 16 mmHg).
Topics: Humans; Middle Aged; Aged; Trabeculectomy; Retrospective Studies; Glaucoma; Intraocular Pressure; Eye; Mitomycin; Treatment Outcome; Follow-Up Studies
PubMed: 36932410
DOI: 10.1186/s12886-023-02860-1 -
Eye (London, England) May 2022To determine difference in surgically induced astigmatism (SIA), post-operative intraocular pressure (IOP) and axial length (AL) between single site and twin-site... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
To determine difference in surgically induced astigmatism (SIA), post-operative intraocular pressure (IOP) and axial length (AL) between single site and twin-site phacotrabeculectomy augmented with Mitomycin C (MMC).
DESIGN
Prospective interventional randomised controlled study.
METHODS
In a prospective interventional comparative study, eligible patients were scheduled for phacotrabeculectomy. They were randomised to either group A: single site or group B: twin-site phacotrabeculectomy with MMC 0.2 mg/mL. Axial length was measured by using Zeiss IOL master I, pre-operatively and at 1, 3, 6 and 12 months post-operatively. Corneal topography was performed using Bausch and Lomb Orbscan I pre-operatively and at 3, 6 and 12 months post-operatively to analyse surgically induced astigmatism. Vector analysis was used to analyse the surgically induced astigmatism.
RESULTS
One hundred and eight eyes of which 55 patients in group A, and 53 patients in group B were enroled for vector analysis. The mean preoperative astigmatic vector power was +0.89 ± 0.4 D and +0.97 ± 0.5 D in group A and B respectively. The mean post-operative astigmatic vector power was +0.78 ± 0.4 D in group A and +0.96 ± 0.5 D in group B at the end of 12 months. Corneal topography showed post-operative superior flattening (51.8% at 3 months and 55.4% at 12 months) in group A (P = 0.072) compared to superior steepening (59.6% at 3 months and 61.5% at 12 months) in group B (P = 0.977).
CONCLUSIONS
The two commonly used techniques of combined cataract and glaucoma surgery proved to be efficacious without significant difference in surgical induced astigmatism.
Topics: Astigmatism; Corneal Topography; Humans; Mitomycin; Phacoemulsification; Prospective Studies
PubMed: 34117400
DOI: 10.1038/s41433-021-01601-2 -
Archivos Espanoles de Urologia May 2018The treatment of non muscle invasive bladder cancer (NMIBC) continues to be a challenge. Hyperthermia (HT) combined with intravesical chemotherapy is used to enhance the... (Review)
Review
OBJECTIVES
The treatment of non muscle invasive bladder cancer (NMIBC) continues to be a challenge. Hyperthermia (HT) combined with intravesical chemotherapy is used to enhance the effects of chemotherapy.
METHODS
A review of the publications was carried out to synthesize the adverse effects (AE) reported by the use of chemohyperthermia (QHT) with Mitomycin-C (MMC). The most relevant data are exposed for each of the devices currently used in the QHT.
RESULTS
SYNERGO®: The dropout rate varied between 3-40%, and the AE rate is up to 88%. The most common AEs were pain (2-40%), thermal reaction of the posterior wall (13-100%), bladder spasms (2-32%), dysuria (3-60%) and hematuria (2-62%). COMBAT BRS®: The dropout rate is 3-11%. The AEs reported were CTCAE Grade 1-2: Pain 13-27%, bladder spasms 6-27%and hematuria 3-20% are the most relevant. In general, CTCAE grade 3-4 toxicity is not reported. UNITHERMIA®: The dropout rate is 7-12%. The AEs described are: Pain 6-23%, bladder spasms 6-23%, hematuria 9-11, frequency 15-25% and allergy 6-11%. The majority of toxicities are CTCAE grade 1-2 (17-53%), with grade 3-4 in 9-15% and Grade 5 in 0-2%. QHT adds little to the AEs of the treatment with MMC. It neither adds severe effects, nor increases dropouts significantly, and does not increase the incidence of allergic reactions. The comparative study between BCG and QHT-MMC, is less likely to present urinary frequency, nocturia, incontinence, hematuria, fever, fatigue and arthralgia in patients in the QHT group.
CONCLUSIONS
QHT has proven to be a safe alternative for the treatment of intermediate and high risk NMIBC, with AE mainly grade 1-2. The AEs reported have little variation with respect to the dose of MMC used, presenting different "profiles" related to the device used for its administration. The treatments with QHTMMC are well tolerated, without adding significantly more AE than the instillations of MMC alone and presenting a better toxicity profile than those reflected in the literature with respect to the treatment with BCG.
Topics: Antibiotics, Antineoplastic; Combined Modality Therapy; Humans; Hyperthermia, Induced; Mitomycin; Neoplasm Invasiveness; Urinary Bladder Neoplasms
PubMed: 29745932
DOI: No ID Found -
PloS One 2014To evaluate the application of the Ologen implant compared to mitomycin C (MMC) on the outcome of trabeculectomy and to examine the balance of risks and benefits. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate the application of the Ologen implant compared to mitomycin C (MMC) on the outcome of trabeculectomy and to examine the balance of risks and benefits.
METHODS
A systematic literature search (Pubmed, Embase, the Cochrane Library, and the Chinese Biomedicine Database) was performed. Randomized controlled trials comparing the Ologen implant with MMC in trabeculectomy were selected. The efficacy measures were the weighted mean differences (WMDs) for the intraocular pressure reduction (IOPR), the reduction in glaucoma medications, and the relative risks (RRs) for success rates. The tolerability measures were RRs for adverse events. The pooled effects were calculated using the random-effects model.
RESULTS
Seven randomized controlled trials including 227 eyes were included in this meta-analysis. The WMDs of the IOPR comparing the Ologen group with the MMC group were -2.98 (95% Cl: -5.07 to -0.89) at one month, -1.41 (-3.72 to 0.91) at three months, -1.69 (-3.68 to 0.30) at six months, -1.94 (-3.88 to 0.01) at 12 months, and 0.65 (-2.17 to 0.47) at 24 months. There was no statistically significance except at one and 12 months after surgery. No significant difference in the reduction in glaucoma medications or complete and qualified success rates were found. The rates of adverse events also did not differ significantly between Ologen and MMC.
CONCLUSIONS
The Ologen implant is comparable with MMC for trabeculectomy in IOP-lowering efficacy, reduction in the number of glaucoma medications, success rates, and tolerability. However, the results should be interpreted cautiously since relevant evidence is still limited, although it is accumulating. Further large-scale, well-designed randomized controlled trials are urgently needed.
Topics: Collagen; Glaucoma; Glycosaminoglycans; Humans; Mitomycin; Prostheses and Implants; Trabeculectomy; Treatment Outcome
PubMed: 24465704
DOI: 10.1371/journal.pone.0085782 -
Translational Vision Science &... Feb 2023The gold standard for managing postoperative ocular fibrosis in glaucoma surgery is the chemotherapeutic mitomycin C (MMC) despite its association with significant...
PURPOSE
The gold standard for managing postoperative ocular fibrosis in glaucoma surgery is the chemotherapeutic mitomycin C (MMC) despite its association with significant adverse effects. This study compares in vitro the antifibrotic efficacy and cytotoxicity of the small-molecule TGFβ1 inhibitor SB-431542 (SB) to MMC.
METHODS
To measure collagen contraction, human Tenon's capsule fibroblasts (HTCFs) embedded in a three-dimensional collagen lattice were exposed to 0.2 mg/mL MMC or 20 µM SB followed by incubation with 2 ng/mL TGFβ1. Total protein extracted from experimentally treated HTCFs underwent immunoblotting for α-smooth muscle actin (α-SMA), matrix metallopeptidase 9 (MMP-9), and EDA splice-variant fibronectin (EDA-FN) expression. Cytotoxicity and cell metabolism were assessed using LIVE/DEAD staining, lactate dehydrogenase (LDH) assay, and methylthiazole tetrazolium (MTT) assay.
RESULTS
Collagen lattice contraction in TGFβ1-induced HTCFs was significantly lowered by SB and MMC. Pretreatment with SB and MMC significantly lowered protein expression of α-SMA, MMP-9, and EDA-FN in HTCFs relative to TGFβ1 alone. HTCF viability in collagen lattices was significantly reduced with MMC pretreatment but not SB pretreatment. MMC-pretreated HTCFs had a significant increase in LDH release after 3 hours and a decrease in MTT activity after 20 minutes, while SB-pretreated HTCFs showed no significant changes via MTT or LDH assay during the same treatment period.
CONCLUSIONS
SB shows comparable efficacy to MMC in reducing expression of fibrosis-promoting proteins in HTCFs and in vitro scarring activity. SB distinguishes itself from MMC by exhibiting less cytotoxicity in both two-dimensional and three-dimensional in vitro assays.
TRANSLATIONAL RELEVANCE
This study demonstrates in vitro the potential of SB as a safer alternative ocular antifibrotic agent.
Topics: Humans; Mitomycin; Tenon Capsule; Cicatrix; Matrix Metalloproteinase 9; Fibroblasts; Collagen; Glaucoma
PubMed: 36826843
DOI: 10.1167/tvst.12.2.31 -
The British Journal of Ophthalmology Jul 2006Multicentre international cooperation would facilitate evaluations of both treatment efficacy and side effects
Multicentre international cooperation would facilitate evaluations of both treatment efficacy and side effects
Topics: Administration, Topical; Antibiotics, Antineoplastic; Conjunctival Neoplasms; Corneal Diseases; Drug Administration Schedule; Humans; Mitomycin; Patient Selection; Treatment Outcome
PubMed: 16782942
DOI: 10.1136/bjo.2006.092734 -
Microbiology Spectrum Dec 2022Multidrug-resistant tuberculosis (MDR-TB) is often associated with poor clinical outcomes. In this study, we evaluated the potential of nosiheptide (NOS) as a new drug...
Multidrug-resistant tuberculosis (MDR-TB) is often associated with poor clinical outcomes. In this study, we evaluated the potential of nosiheptide (NOS) as a new drug candidate for treating Mycobacterium tuberculosis infections, including MDR-TB. The antimicrobial susceptibility testing was performed to determine the MICs of NOS against 18 reference strains of slowly growing mycobacteria (SGM) and 128 clinical isolates of M. tuberculosis. The postantibiotic effects (PAE) and interaction with other antituberculosis drugs of NOS were also evaluated using M. tuberculosis H37Rv. Fifteen out of the 18 tested reference strains of SGM had MICs far below 1 μg/mL. From the 128 M. tuberculosis clinical isolates, the MIC and MIC were 0.25 μg/mL and 1 μg/mL, respectively; the tentative epidemiological cutoff (ECOFF) was defined at 1 μg/mL. Furthermore, a Lys89Thr mutation was found in one M. tuberculosis isolate with a MIC of NOS >8 μg/mL. After 24 h of incubation, NOS at 1 μg/mL inhibited 25.79 ± 1.22% of intracellular bacterial growth, which was comparable with the inhibitory rate of 25.71 ± 3.67% achieved by rifampin at 2 μg/mL. Compared to rifampicin and isoniazid (INH), NOS had a much longer PAE, i.e., a value of about 16 days. In addition, a partial synergy between NOS and INH was observed. NOS has potent inhibitory activities against M. tuberculosis as well as in macrophages. Furthermore, the long PAE and partial synergistic effect with INH, in addition to the added safety of long-term use as a feed additive in husbandry, provide support for NOS being a promising drug candidate for tuberculosis treatment. This study is aimed at chemotherapy for MDR-TB, mainly to explore the anti-TB activity of the existing chemotherapeutic reagent. We found that NOS has potent inhibitory activities against M. tuberculosis regardless of the drug-resistant profile. Furthermore, NOS also showed the long PAE and partial synergistic effect with INH and is nontoxic, providing support for its promise as a drug candidate for drug-resistant tuberculosis treatment.
Topics: Humans; Mycobacterium tuberculosis; Antitubercular Agents; Isoniazid; Tuberculosis, Multidrug-Resistant; Rifampin; Microbial Sensitivity Tests; Mitomycin
PubMed: 36222690
DOI: 10.1128/spectrum.01444-22