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Abstract #18286 Published in IGR 3-3
Suramin to enhance glaucoma filtering procedures: a clinical comparison with mitomycin
Mietz H; Krieglstein GKOphthalmic Surgery and Lasers 2001; 32: 358-369
BACKGROUND AND OBJECTIVE: Trabeculectomies performed with mitomycin are more likely to be successful, but have an increased rate of complications. The authors performed a novel approach to enhance the outcome of trabeculectomies using suramin, a substance that inhibits the action of growth factors. MATERIALS AND METHODS: Trabeculectomies were performed in ten eyes of ten patients with advanced stages of complicated glaucoma and/or poor visual prognosis in a prospective, consecutive study. For comparison, an equal number of matched controls were selected from surgical cases using mitomycin, as well as a further 20 cases without mitomycin. Pre- and postoperative data were evaluated, as well as complications and the need for further surgeries. RESULTS: The follow up was 18 months in all groups. Average IOP values decreased from 32.7 and 29.5 mmHg to 19.7 and 19.3 mmHg in the suramin and mitomycin groups, respectively. The average number of medications decreased from 2.6 and 2.5 (p < 0.86, t test) to 1.3 and 0.4 (p < 0.027) in the suramin- and mitomycin-treated eyes, respectively, at the last visit. Hypotony following trabeculectomy occurred in two of ten cases in suramin-treated eyes and in five of ten cases in mitomycin-treated eyes (p < 0.18). Hypotony lasting for more than three months occurred in none of the ten suramin-treated eyes and in five of the ten mitomycin-treated eyes. Conjunctival dehiscence (2/10), choroidal detachment (4/10), hypotony maculopathy (1/10), and endophthalmitis (1/10) were only noted in mitomycin-treated eyes. Without mitomycin, 60% of surgeries performed failed. CONCLUSIONS: In this first study using suramin to inhibit fibrosis following trabeculectomy for complicated cases of glaucoma, it appears that the use of suramin is associated with fewer cases of severe hypotony, choroidal detachment, and severe visual loss compared to mitomycin, while the success rates seem to be similar.
Dr H. Mietz, Department of Ophthalmology, University of Cologne, 50924 Cologne, Germany. h.mietz@unikoeln.de
Classification:
12.8.10 Woundhealing antifibrosis (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
