Antimetabolites in Glaucoma Surgery -the Long Term Study

Overview

Purpose:
To observe the long term success of antimetabolites used in glaucomafiltering surgery in eyes with high risc of failure.Material and method:Two groups of patients undergone trabeculectomy with theuse of antimetabolites 5-Fluorouracil (5-FU)and Mitomycin (MMC)are includedin this retrospective study.5-FU was administered postoperatively 1-10 times inthe dose of 5 mg/ml in subconjunctival injection on 32eyes.Follow up time rangedfrom 8 months to 9 years.Mitomycin C was administered intraoperatively in thedose of 0,2mg/ml,on subconjunctival sponge with application time from 3 to 5minutes on 15 eyes.Follow up time ranged from 7 month to 4,5 years.Results:Intraocular pressure (IOP)before operation with the use of 5-FU was inaverage 28,8 mmHg (22-50 mmHg)at the end of therapy with 5-FU was 17,6 mmHg(10-30 mmHg)and in the last examination was on average 19,5 mmHg (14-28mmHg).IOP before operation with the use of MMC was in average 30,3 mmHg(22-40 mmHg),the seventh day after administration of MMC 12,7 mmHg (6-20mmHg)and in the last examination was in average 18 mmHg(9-28 mmHg).Duringthe long term observation of IOP values in the 5-FU group there was 79,2%success andin the MMCgroupthere was 83,3 %success (IOPupto20 mmHgwithor withouttherapy).Decrease of IOP was statistically significant.Conclusion:Antimetabolites improve the success of filtering surgery in high riscglaucomas.The long term follow up shows that failure of filtration in these typesof glaucomas is still a serious clinical problem.

Key words:
Glaucoma,filtering surgery,antimetabolites,Mitomycin ,5-Fluorou-racil