Glaucoma filtration surgery and antimetabolites

Two studies compared the success of filtration surgery in high-risk eyes using postoperative 5-FU and mitomycin-C, and found that IOPs are lower, and fewer postoperative glaucoma medications are required for control in eyes treated with mitomycin. A similar number of complications occurred in both groups except for a higher incidence of corneal toxicity in the 5-FU treated eyes. Mitomycin-C offers the additional convenience of a single intraoperative application. 5-FU also may be used as an intraoperative application, but no studies have been published regarding its comparable efficacy or safety compared with mitomycin-C. 5-FU has the advantage of being able to use it at any time in the early postoperative course when bleb inflammation arises. 5-FU has known complications, while mitomycin-C, although it appears relatively safe, has been used in fewer patients so far. The advantage of greater surgical success, with lower intraocular pressures, puts antimetabolites into the armamentarium of every surgeon who performs glaucoma procedures.