Role of 5 fluorouracil in the management of failed glaucoma surgery

Filtering surgery for glaucoma usually controls the intraocular pressure adequately. However, in glaucoma patients with aphakia, neovascularisation of iris, previous failed filtering surgeries and relatively young patients, results of surgery leave much scope for improvement. Most failures of filtering surgery are related to extra-ocular factors. Histopathological studies of eyes after failed filtering operations have suggested that proliferation of fibroblasts and deposition of collagen constitute a barrier to filteration. There is also a positive correlation between success of filtering surgery and inhibition of fibroblast growth by the patients aqueous humour. Thus agents inhibiting fibroblast proliferation should play an important role in increasing the success rate of filtering surgery. 5 Fluorouracil is a pyrimidine analogue which has been utilised for over 15 years as an antimetabolite in cancer therapy. Its efficiency in inhibiting fibroblast proliferation in vitro and in rabbit eyes has been proved beyond doubt. We undertook a pilot project to estimate the efficiency of the subconjunctival 5 FU to increase the changes of success in problematic cases of glaucoma in pigmented eyes.