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Abstract #15947 Published in IGR 2-3
Clinical perspectives on glaucoma-filtering surgery: antiproliferative agents
Reynolds AC; Skuta GLOphthalmology Clinics of North America 2000; 13: 501-515
Both 5-FU and mitomycin appear to enhance surgical success after glaucoma filtering surgery, although mitomycin appears to be more effective in high-risk eyes. Unfortunately, these agents, and mitomycin in particular, are more often associated with early and late hypotony, late bleb leaks, and bleb-related infections. In high-risk eyes (e.g., those with aphakia or pseudophakia, previously failed filters, a history of anterior segment neovascularization, and uveitis) the authors generally use mitomycin. Given the potential concerns regarding hypotony in primary trabeculectomies, the authors currently prefer a regimen of 5-FU in procedures, typically a 50 mg/ml intraoperative application supplemented by two to four 5-mg subconjunctival injections during the postoperative period. The authors use mitomycin selectively in primary procedures (e.g., failure of primary procedure with 5-FU in the fellow eye, concerns regarding 5-FU injections, and patients with advanced damage or a need for low IOPs). It is hoped that ongoing studies will better define the relative roles of 5-FU and mitomycin in primary trabeculectomies. Regarding the pharmacological manipulation of would healing, future work will be directed toward (1) gaining a better understanding of mitomycin's effects on ocular tissues; (2) establishing concentrations and/or exposure times for individual patients or groups of patients that maximize glaucoma control but minimize complications such as hypotony; (3) improving our ability to prevent and treat hypotony and hypotonous maculopathy, bleb leaks, and bleb-related infections; (4) determining a more precise role for mitomycin in combined cataract and glaucoma surgeries; (5) evaluating the effect of various growth factors and related agents in the wound healing process; and (6) comparing trabeculectomy with 5-FU or mitomycin to procedures such as aqueous shunt surgery, viscocanalostomy, and deep sclerectomy with or without collagen implants. Clinical investigators must continue to vigorously evaluate the long-term safety and efficacy of mitomycin, 5-FU, and other antiproliferative agents as adjuncts to glaucoma filtering surgery and also seek surgical alternatives that achieve glaucoma control but reduce the risks associated with current techniques.
Dr. G.L. Skuta, Dean A. McGee Eye Institute, 608 Stanton L. Young Boulevard, Oklahoma City, OK 73104, USA
Classification:
12.8.10 Woundhealing antifibrosis (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
