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Glaucoma filtration surgery and antimetabolites
1New England Eye Center, Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02111, USA.
Ophthalmic Surgery and Lasers
|September 1, 1995
Summary
Mitomycin-C demonstrates superior efficacy in glaucoma filtration surgery compared to 5-FU, resulting in lower intraocular pressures and reduced medication needs. While both agents have complications, mitomycin-C offers convenience and appears safer, making antimetabolites valuable for glaucoma surgeons.
Area of Science:
- Ophthalmology
- Glaucoma Surgery
- Pharmacology
Background:
- Filtration surgery is a key procedure for managing glaucoma.
- Postoperative adjunctive medications are often necessary to enhance surgical success and control intraocular pressure (IOP).
- Antimetabolites like 5-fluorouracil (5-FU) and mitomycin-C are commonly used to modulate scarring and improve surgical outcomes.
Purpose of the Study:
- To compare the efficacy and safety of postoperative 5-fluorouracil (5-FU) versus mitomycin-C in high-risk glaucoma filtration surgery.
- To evaluate the impact of these antimetabolites on intraocular pressure (IOP) control and the requirement for postoperative glaucoma medications.
- To assess the complication profiles associated with each agent.
Main Methods:
- Two comparative studies were conducted.
- High-risk eyes undergoing filtration surgery were treated with either 5-FU or mitomycin-C postoperatively.
- Outcomes measured included IOP, need for glaucoma medications, and incidence of complications.
Main Results:
- Eyes treated with mitomycin-C achieved significantly lower IOPs and required fewer postoperative glaucoma medications compared to those treated with 5-FU.
- A similar overall complication rate was observed between the two groups.
- Corneal toxicity was more frequent in the 5-FU group, whereas mitomycin-C offered the advantage of a single intraoperative application.
Conclusions:
- Mitomycin-C appears to be more effective than 5-FU in enhancing glaucoma filtration surgery success, leading to better IOP control and reduced medication dependence.
- While 5-FU offers flexibility for later postoperative use, mitomycin-C's safety profile and single-dose convenience are advantageous.
- Both antimetabolites are valuable tools for glaucoma surgeons, with mitomycin-C showing a favorable risk-benefit profile in this comparison.