Primate trabeculectomies with 5-fluorouracil collagen implants.

Area of Science:

• Ophthalmology
• Surgical Innovation
• Drug Delivery Systems

Background:

• Glaucoma filtering surgery aims to reduce intraocular pressure.
• 5-fluorouracil (5-FU) is an antifibrotic agent used to enhance surgical success.
• Novel drug delivery systems are needed to optimize antifibrotic agent efficacy.

Purpose of the Study:

• To evaluate bovine collagen implants as a drug delivery system for 5-fluorouracil in glaucoma filtering surgery.
• To assess the impact of 5-FU loaded collagen implants on surgical outcomes and inflammatory response in a primate model.

Main Methods:

• Bilateral trabeculectomies were performed on four cynomolgus monkeys.
• Collagen implants containing 5-FU or saline were placed under scleral flaps.
• Clinical and histopathologic assessments were conducted six weeks postoperatively.

Main Results:

• 5-FU treated eyes showed more open ostia but similar intraocular pressures and filtering blebs compared to controls.
• Mild lenticular changes were observed in half of the eyes in both groups.
• All implants elicited foreign body giant cell reactions, with delayed/less vigorous responses in 5-FU treated eyes.

Conclusions:

• Bovine collagen implants are an ineffective drug delivery system for 5-FU in this glaucoma surgery model.
• The implants induced a granulomatous inflammatory reaction, potentially hindering antifibrotic effects.
• Further research into alternative drug delivery methods for glaucoma surgery is warranted.