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Subspecialties Glaucoma, Health Economics and Policy

Drug Drought

Europe and Asia are currently afflicted by a sudden availability crisis of mitomycin C (MMC). This is significant as the majority of trabeculectomy procedures performed in modern times utilize antimetabolites, and 63 percent of those use MMC (1). After an issue with the sterile processing of the drug was detected, Kyowa Kirin – a Japanese pharmaceutical and biotechnology company – ceased production of MMC pending investigation, and a Class 2 product recall of all shelf stock is currently underway. In the UK, Kyowa Kirin’s drug is the only MMC product licensed for ophthalmic use. MMC licensed for intravesical application is still available in theory but supply is taken up by urological cancer requirements, leaving no surplus. Other routes of non-licensed supply were available, but the instant surge in demand meant those were quickly exhausted. This has left the UK, Europe and parts of Asia with no access to MMC, and hence trabeculectomy, tube shunt surgery and sub-conjunctival MIGS procedures (such as XEN or PRESERFLO) face significant challenges. The effects are expected to last at least until spring 2020.

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About the Authors

Obeda Kailani

Glaucoma fellow at the Western Eye Hospital, Imperial College London, England, UK.


Claudia Quijano

Glaucoma fellow at Guy’s and St Thomas’ NHS Foundation Trust, England, UK.


Dan Lindfield

Dan Lindfield is a consultant ophthalmic surgeon at Optegra, and glaucoma lead at Royal Surrey County Hospital, England, UK.

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