Glaucoma filtering surgery with postoperative 5-fluorouracil in patients with intraocular inflammatory disease.

Twenty-one eyes of 18 patients with uncontrolled glaucoma and intraocular inflammatory disease had glaucoma filtering surgery with postoperative subconjunctival 5-fluorouracil (5-FU). Follow-up for eyes in which intraocular pressure was controlled ranged from 6 to 53 months (mean, 34 months; median, 35 months). Fifteen of 21 eyes (71%) had controlled intraocular pressure (21 mmHg or less). Control was achieved in 9 of 10 (90%) phakic eyes and in 6 of 11 (55%) aphakic or pseudophakic eyes with or without glaucoma medication. Four of six filter failures had a second filtering procedure with 5-FU, and of these four procedures, three were successful. Cataract progression occurred in 9 of 10 phakic eyes, leading to cataract surgery in 7 eyes. Other complications included corneal epithelial defects in 13 eyes, bleb leaks in 3 eyes, choroidal effusions in 13 eyes, 1 choroidal hemorrhage, 1 serous retinal detachment and macular retinal pigment epithelial disturbance associated with hypotony and choroidal effusion. Filtering surgery with postoperative subconjunctival 5-FU can successfully control intraocular pressure in eyes with ocular inflammatory disease.     

Serious corneal complications of glaucoma filtering surgery with postoperative 5-fluorouracil

We studied four patients who, having received postoperative 5-fluorouracil after glaucoma filtering operations, developed serious corneal complications. All four patients had preexisting corneal abnormalities including keratoconjunctivitis sicca, exposure keratopathy, and bullous keratopathy. All of the patients developed epithelial defects in the postoperative period. The complications included bacterial corneal ulceration (two patients), sterile corneal ulceration and corneal perforation (one patient), and a keratinized corneal plaque with underlying sterile stromal infiltrate (one patient). The use of 5-fluorouracil, which is an antimetabolite with considerable corneal epithelial toxicity, after glaucoma filtering surgery frequently causes corneal epithelial defects that may lead to secondary complications. Patients receiving this drug should have their corneal status closely monitored. In patients with corneal epithelial disease, 5-fluorouracil should be used with caution.     

Glaucoma filtration surgery in rabbits using bioerodible polymers and 5-fluorouracil

A prospective, randomized, double-masked, and placebo-controlled study was performed to examine the effect of a localized and sustained delivery of 5-fluorouracil (5-FU) on the success of glaucoma filtration surgery in 18 rabbits. A bioerodible polyanhydride composed of bis (p-carboxyphenoxy) hexane (PCPH) and sebacic acid (SA) was used as the drug carrier. The polymer and 5-FU (10% by weight) were molded into 4-mm long cylinders by a 15-gauge needle. These implants, with and without the therapeutic agent, were placed at the site of filtration surgery intraoperatively. The results showed that intraocular pressures (IOPs) were lower in the experimental eyes during the second postoperative week, but eventually both experimental and control eyes returned to preoperative levels. Filtration blebs lasted longer in experimental eyes and bleb failure occurred before IOP failure in both experimental and control eyes. Implant disappearance occurred after IOP and bleb failure. Experimental eyes had more postoperative complications than control eyes. Eventually, the filtration surgery failed in both the experimental and control rabbit eyes.     

5-fluorouracil and glaucoma filtering surgery: I. An animal model

Failure of a glaucoma filtering procedure commonly results from scarring at the surgical site. Fibroblasts play an important role in the scarring process. 5-fluorouracil is an antimetabolite capable of inhibiting fibroblast proliferation. We tested the ability of 5-fluorouracil to inhibit cicatrization at the filtering site in an experimental model. Posterior lip sclerectomies were performed in each eye of ten normal owl monkeys. Postoperatively, one eye of each animal received subconjunctival injections of fluorouracil and the fellow eye received saline injections in a randomized, masked fashion. Two animals died of undetermined causes. None of the control eyes developed blebs, but six of the eight treated eyes in surviving animals developed blebs. The difference between intraocular pressures in fluorouracil-treated and control eyes was statistically significant (P less than 0.05). Signs of ocular toxicity included persistent corneal epithelial defects and delayed healing of the conjunctival incision. These results are considerably more favorable than those previously reported with experimental filtering procedures in non-human primates. Pharmacologic modulation of wound healing may decrease the risk of failure of filtering operations.     

Intraoperative mitomycin versus postoperative 5-fluorouracil in high-risk glaucoma filtering surgery.

In a randomized clinical trial, the authors compared the use of postoperative subconjunctival injections of 5-fluorouracil (5-FU) in 19 eyes with a single intraoperative application of subconjunctival mitomycin (MMC) at the filtering site in 20 eyes at high risk for failure of glaucoma filtering surgery. Six months after surgery, intraocular pressures averaged 10.9 +/- 5.3 mmHg (mean +/- standard deviation) in the MMC-treated eyes versus 14.2 +/- 5.5 mmHg in the 5-FU-treated eyes (P = 0.08) and were less than or equal to 12 mmHg in 60.0% of MMC-treated eyes and 21.1% of 5-FU-treated eyes (P = 0.03). Mitomycin-treated eyes were receiving an average of 0.3 +/- 0.5 medications for intraocular pressure control, and 5-FU-treated eyes were receiving an average of 1.1 +/- 1.1 medications (P = 0.01). Drug-induced corneal epithelial defects were seen in nine 5-FU-treated eyes and in no MMC-treated eyes (P = 0.0004). These results suggest that intraoperative MMC may be a viable alternative to postoperative 5-FU, with lower overall intraocular pressures, decreased dependence on postoperative ocular antihypertensive medications, and decreased corneal toxicity.     

5-fluorouracil and glaucoma filtering surgery. II. A pilot study

5-Fluorouracil (5-FU) was injected subconjunctivally after glaucoma filtering surgery in a pilot study of eyes with poor surgical prognoses. Twenty-seven (79%) of the 34 aphakic eyes with glaucoma achieved an intraocular pressure (IOP) of less than or equal to 21 mmHg (range of follow-up on nonreoperated eyes, 91 -468 days). Nine (69%) of 13 eyes with neovascular glaucoma achieved an IOP of less than or equal to 21 mmHg (range of follow-up on nonreoperated eyes, 120-379 days). Eight (89%) of nine phakic eyes with glaucoma following unsuccessful filtering procedures achieved an IOP of less than or equal to 21 mmHg (range of follow-up on nonreoperated eyes, 134-394 days). Visual acuities remained within one line of their preoperative levels or improved in 32 (94%) of the 34 aphakic eyes with glaucoma, eight (62%) of the 13 eyes with neovascular glaucoma, and six (67%) of the nine phakic eyes with glaucoma following unsuccessful filtering procedures. Postoperative corneal epithelial defects occurred in 45% of the cases. Conjunctival wound and conjunctival needle tract leaks were observed in 41% of the cases, but only one eye required wound revision. No other serious side effects that we attributed to 5-FU were observed. It seems that postoperative subconjunctival 5-FU increases the likelihood of achieving IOP control following filtering surgery in eyes with poor surgical prognoses; however, a randomized clinical trial is necessary to confirm this.     

Sturge-Weber综合征继发青光眼的手术治疗

Objective To evaluate the efficacy and complications of anti-glaucoma surgery in child-hood with Sturge Weber syndrome (SWS) and secondary glaucoma. Methods We have performed glaucoma filtering surgery in 6 patients (10 eyes) with SWS and secondary glaucoma. Results The mean intraocular pressure (IOP) was 34.3mmHg (25.81～50.62 mmHg) preoperatively. ARe, surgery, the mean lOP in all cases was 22.22mmHg ( 14.75～30.82 mmHg) and in the end of follow-up,IOP of 5 patients were controlled to nor-real. We have not observed any intraopemtive or postoperative complications. Conclusion The better safety and efficacy of glaucoma filtering surgery could be obtained in patients with SWS.     

干扰素α-2b与实验性滤过性手术

为探讨干扰素α-2b(interferon-alpha2b,IFNα-2b)在不同给药方法及不同剂量下对兔眼抗青光眼术后滤过泡的影响,选取新西兰纯种白兔20只,全部行标准统一的巩膜咬切术,采用湿棉片敷贴给药和结膜下注射的方法,与对照组相比,观察术后的疗效,包括滤过泡存留情况、滤过区组织学检查、成纤维细胞计数和术后并发症.结果湿棉片敷贴5×105IU/ml或1×106IU/mlIFNα-2b5分钟,与对照组相比,疗效均无明显差别;结膜下注射5×105IU或1×105IU能有效减少滤过区疤痕组织增生,且5×105IU效果比1×105IU好;实验条件下,未引起明显的眼部并发症.     

Sturge-Weber综合征继发青光眼的手术治疗

Objective To evaluate the efficacy and complications of anti-glaucoma surgery in child-hood with Sturge Weber syndrome (SWS) and secondary glaucoma. Methods We have performed glaucoma filtering surgery in 6 patients (10 eyes) with SWS and secondary glaucoma. Results The mean intraocular pressure (IOP) was 34.3mmHg (25.81～50.62 mmHg) preoperatively. ARe, surgery, the mean lOP in all cases was 22.22mmHg ( 14.75～30.82 mmHg) and in the end of follow-up,IOP of 5 patients were controlled to nor-real. We have not observed any intraopemtive or postoperative complications. Conclusion The better safety and efficacy of glaucoma filtering surgery could be obtained in patients with SWS.     

Sturge-Weber综合征继发青光眼的手术治疗

Objective To evaluate the efficacy and complications of anti-glaucoma surgery in child-hood with Sturge Weber syndrome (SWS) and secondary glaucoma. Methods We have performed glaucoma filtering surgery in 6 patients (10 eyes) with SWS and secondary glaucoma. Results The mean intraocular pressure (IOP) was 34.3mmHg (25.81～50.62 mmHg) preoperatively. ARe, surgery, the mean lOP in all cases was 22.22mmHg ( 14.75～30.82 mmHg) and in the end of follow-up,IOP of 5 patients were controlled to nor-real. We have not observed any intraopemtive or postoperative complications. Conclusion The better safety and efficacy of glaucoma filtering surgery could be obtained in patients with SWS.     

Sturge-Weber综合征继发青光眼的手术治疗

Objective To evaluate the efficacy and complications of anti-glaucoma surgery in child-hood with Sturge Weber syndrome (SWS) and secondary glaucoma. Methods We have performed glaucoma filtering surgery in 6 patients (10 eyes) with SWS and secondary glaucoma. Results The mean intraocular pressure (IOP) was 34.3mmHg (25.81～50.62 mmHg) preoperatively. ARe, surgery, the mean lOP in all cases was 22.22mmHg ( 14.75～30.82 mmHg) and in the end of follow-up,IOP of 5 patients were controlled to nor-real. We have not observed any intraopemtive or postoperative complications. Conclusion The better safety and efficacy of glaucoma filtering surgery could be obtained in patients with SWS.     

Sturge-Weber综合征继发青光眼的手术治疗

Objective To evaluate the efficacy and complications of anti-glaucoma surgery in child-hood with Sturge Weber syndrome (SWS) and secondary glaucoma. Methods We have performed glaucoma filtering surgery in 6 patients (10 eyes) with SWS and secondary glaucoma. Results The mean intraocular pressure (IOP) was 34.3mmHg (25.81～50.62 mmHg) preoperatively. ARe, surgery, the mean lOP in all cases was 22.22mmHg ( 14.75～30.82 mmHg) and in the end of follow-up,IOP of 5 patients were controlled to nor-real. We have not observed any intraopemtive or postoperative complications. Conclusion The better safety and efficacy of glaucoma filtering surgery could be obtained in patients with SWS.     

Sturge-Weber综合征继发青光眼的手术治疗

Objective To evaluate the efficacy and complications of anti-glaucoma surgery in child-hood with Sturge Weber syndrome (SWS) and secondary glaucoma. Methods We have performed glaucoma filtering surgery in 6 patients (10 eyes) with SWS and secondary glaucoma. Results The mean intraocular pressure (IOP) was 34.3mmHg (25.81～50.62 mmHg) preoperatively. ARe, surgery, the mean lOP in all cases was 22.22mmHg ( 14.75～30.82 mmHg) and in the end of follow-up,IOP of 5 patients were controlled to nor-real. We have not observed any intraopemtive or postoperative complications. Conclusion The better safety and efficacy of glaucoma filtering surgery could be obtained in patients with SWS.     

Sturge-Weber综合征继发青光眼的手术治疗

Objective To evaluate the efficacy and complications of anti-glaucoma surgery in child-hood with Sturge Weber syndrome (SWS) and secondary glaucoma. Methods We have performed glaucoma filtering surgery in 6 patients (10 eyes) with SWS and secondary glaucoma. Results The mean intraocular pressure (IOP) was 34.3mmHg (25.81～50.62 mmHg) preoperatively. ARe, surgery, the mean lOP in all cases was 22.22mmHg ( 14.75～30.82 mmHg) and in the end of follow-up,IOP of 5 patients were controlled to nor-real. We have not observed any intraopemtive or postoperative complications. Conclusion The better safety and efficacy of glaucoma filtering surgery could be obtained in patients with SWS.     

Sturge-Weber综合征继发青光眼的手术治疗

目的 总结Sturge-weber(sws)继发青光眼的手术治疗效果.方法 选自1999年11月至2005年12月连续6例10只眼SWS病例,对其进行手术治疗.观察手术近期及远期的眼压控制结果及并发症发生情况.结果 术前眼压25.81～50.62mmHg,平均34.3mmHg.术后近期眼压14.57～30.82mmHg,平均22.22mmHg,远期1例失访外眼压全部控制正常.眼底视盘没有进行性改变.没有术中术后.并发症发生.结论 对SWS病例严格掌握手术适应证,术前充分控制眼压,术中精细操作,仍可获得较高的手术成功率.     

Sturge-Weber综合征继发青光眼的手术治疗

Objective To evaluate the efficacy and complications of anti-glaucoma surgery in child-hood with Sturge Weber syndrome (SWS) and secondary glaucoma. Methods We have performed glaucoma filtering surgery in 6 patients (10 eyes) with SWS and secondary glaucoma. Results The mean intraocular pressure (IOP) was 34.3mmHg (25.81～50.62 mmHg) preoperatively. ARe, surgery, the mean lOP in all cases was 22.22mmHg ( 14.75～30.82 mmHg) and in the end of follow-up,IOP of 5 patients were controlled to nor-real. We have not observed any intraopemtive or postoperative complications. Conclusion The better safety and efficacy of glaucoma filtering surgery could be obtained in patients with SWS.     

Sturge-Weber综合征继发青光眼的手术治疗

Objective To evaluate the efficacy and complications of anti-glaucoma surgery in child-hood with Sturge Weber syndrome (SWS) and secondary glaucoma. Methods We have performed glaucoma filtering surgery in 6 patients (10 eyes) with SWS and secondary glaucoma. Results The mean intraocular pressure (IOP) was 34.3mmHg (25.81～50.62 mmHg) preoperatively. ARe, surgery, the mean lOP in all cases was 22.22mmHg ( 14.75～30.82 mmHg) and in the end of follow-up,IOP of 5 patients were controlled to nor-real. We have not observed any intraopemtive or postoperative complications. Conclusion The better safety and efficacy of glaucoma filtering surgery could be obtained in patients with SWS.     

Sturge-Weber综合征继发青光眼的手术治疗

Objective To evaluate the efficacy and complications of anti-glaucoma surgery in child-hood with Sturge Weber syndrome (SWS) and secondary glaucoma. Methods We have performed glaucoma filtering surgery in 6 patients (10 eyes) with SWS and secondary glaucoma. Results The mean intraocular pressure (IOP) was 34.3mmHg (25.81～50.62 mmHg) preoperatively. ARe, surgery, the mean lOP in all cases was 22.22mmHg ( 14.75～30.82 mmHg) and in the end of follow-up,IOP of 5 patients were controlled to nor-real. We have not observed any intraopemtive or postoperative complications. Conclusion The better safety and efficacy of glaucoma filtering surgery could be obtained in patients with SWS.     

青光眼滤过术后合并睫状体脉络膜脱离的恶性青光眼

目的探讨青光眼滤过术后合并睫状体脉络膜脱离的恶性青光眼的发病机制、临床特点及预防。方法对4例（4只眼）青光眼滤过术后合并睫状体脉络膜脱离的恶性青光眼患者的临床资料进行回顾性分析。结果 4例（4只眼）在术后早期即出现Ⅱ°、Ⅲ°浅前房,通过眼底检查、手术及超声生物显微镜（UBM）检查发现睫状体脉络膜脱离、睫状环阻滞,经睫状体脉络膜上腔放液,并根据病情联合玻璃体水囊抽吸、前段玻璃体切除以及晶状体手术等,所有患眼眼压均恢复正常,前房加深,脉络膜脱离消失。结论睫状体脉络膜脱离是发生恶性青光眼的诱发因素,预防睫状体脉络膜脱离是预防恶性青光眼发生的关键;对术后早期即出现的Ⅱ°、Ⅲ°浅前房,及时进行UBM检查有助于明确诊断,可减少治疗的盲目性。     

Dose,timing and frequency of subconjunctival 5-fluorouracil injections after glaucoma filtering surgery

BACKGROUND: Although adjunctive postoperative 5-fluorouracil (5-FU) injections are known to improve the success rate of glaucoma surgery, it is still unknown what dose, timing and frequency of application will give the best results with respect to the inhibition of postoperative scarring and intraocular pressure regulation. We therefore designed the following retrospective investigation. METHODS: We studied 172 eyes from 172 patients who had undergone trabeculectomy with adjuvant 5-FU-therapy. Variations of dosage, timing and frequency were analysed retrospectively. Surgery was defined as a complete success when the patient reached an intraocular pressure under 21 mmHg and a reduction of 20% 12 months after the operation. A relative success was achieved with these criteria under additional local medication. Not reaching these postoperative criteria for a complete success was classified as failure. RESULTS: On average, adjunctive 5-FU-treatment was started 4.6+/-5.85 days postoperatively. The injections contained between 2 mg and 5 mg FU, and the mean total dose was 26.6+/-13.2 mg (range 5-65 mg). Surgery on 94 patients (54.65%) was classified as "complete success", that on 25 patients (14.53%) was classified as "relative success" and that on 53 eyes (30.81%) was classified as "failure" 12 months (+/-3 months) postoperatively. The best results were obtained when the treatment started on or before the first postoperative day (68.0-71.4% complete success; P<0.05). In contrast, an increase in 5-FU dosage did not result in an increased success rate of trabeculectomy. None of the 172 patients suffered from vision-threatening complications such as endophthalmitis or hypotony maculopathy. CONCLUSION: Early treatment with 5-FU significantly increases the success rates of filtering surgery.