Glaucoma Filtering Surgery with 5-Fluorouracil

Rockwood, Edward J.; Parrish, Richard K.; Heuer, Dale K.; Skuta, Gregory L.; Hodapp, Elizabeth; Palmberg, Paul; Gressel, Michael G.; Feuer, William J.

doi:10.1016/s0161-6420(87)33321-4

Cited by 207 publications

(59 citation statements)

References 30 publications

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“…One study had a reported success rate of 68% with 5-FU at 3 years. 32 In a study 33 of 35 eyes who had undergone trabeculectomy with Mitomycin C for NVG due to diabetic retinopathy, the complications encountered in the early postoperative period were hyphema (34.3%), shallow AC (20.0%), and vitreous hemorrhage (22.9%). In another study, 34 out of 15 eyes one patient developed hyphema, while another had shallow anterior chamber.…”

Section: Use Of Antifibrotic Agentsmentioning

confidence: 99%

Management of Neovascular Glaucoma

Dubey¹,

Pegu²

2009

JOCGP

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Management of NVG remains a therapeutic challenge. The diagnosis of NVG should be made as early as possible if the patient is to be provided the best chance to maintain vision. To achieve this goal, a high index of suspicion, a full ocular examination including undilated gonioscopy, and pupil examination are essential. There are two key aspects to the management of NVG: treatment of the underlying disease process responsible for rubeosis and treatment of the increased IOP. Treatment of rubeosis is directed at the ischemic retina in most cases. Panretinal photocoagulation (PRP) is considered the treatment of choice. However, other modalities such as panretinal cryotherapy, transscleral diode laser retinopexy, and panretinal diathermy have been described. Medical management of NVG consists of IOP-lowering agents, including topical ß-adrenergic antagonists, alpha-2 agonists, and topical and oral carbonic anhydrase inhibitors. However, once the angle is synechially closed, medical management becomes unsuccessful and one has to resort to surgical management. Although the ideal surgical procedure has yet to be determined, trabeculectomy with antimetabolite therapy, aqueous shunt implants, and diode laser cyclophotocoagulation are the best current surgical options. Studies have shown VEGF as a key molecule in ocular angiogenesis and direct targeting of VEGF might be another possible therapeutic strategy to treat neovascularization.

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Section: Use Of Antifibrotic Agentsmentioning

confidence: 99%

Management of Neovascular Glaucoma

Dubey¹,

Pegu²

2009

JOCGP

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“…[11][12][13][14][15] Aqueous leakage from filtering blebs is not a rare condition after trabeculectomy with antimetabolites. 1,2,4,[10][11][12]14,16,17 Previous studies revealed the prevalence of aqueous leakage as 1.4% after trabeculectomy with 5-FU 17 and 3.7% with MMC, 17 and the probability of aqueous leakage estimated with the life-table method was 4.2% at 6 years after surgery with 5-FU. 18 There are two types of aqueous leakage: pointleaks and oozing: The former is leakage with a visible aqueous stream from a leak point, and the latter is transconjunctival aqueous egress without a focal leak point.…”

Section: Introductionmentioning

confidence: 96%

“…[1][2][3][4][5][6] However, because avascular blebs with thin walls are more commonly obtained after trabeculectomy with antimetabolites, [7][8][9][10] blebrelated complications, such as hypotony due to a bleb leak, blebitis, and endophthalmitis, are increasing. [11][12][13][14][15] Aqueous leakage from filtering blebs is not a rare condition after trabeculectomy with antimetabolites.…”

Section: Introductionmentioning

confidence: 99%

Topical application of autologous serum for the treatment of late-onset aqueous oozing or point-leak through filtering bleb

Matsuo

Tomidokoro

Tomita

et al. 2004

Eye

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Purpose To evaluate the efficacy of topical autologous serum application to stop aqueous oozing or point-leak through filtering bleb after trabeculectomy. Patients and Methods A total of 21 consecutive eyes with oozing and 21 eyes with a point-leak through a functional bleb after trabeculectomy with 5-fluorouracil or mitomycin C were enrolled in this randomized, case-control study. In eyes randomly assigned to the serum group, an antibiotic and the autologous serum, which was sterilely diluted to 20% with physiological saline, were topically applied four times a day for up to 12 weeks. In eyes assigned to the control group, the antibiotic alone was applied according to the same protocol. Intraocular pressure (IOP) and the presence of oozing or a point-leak were tested before and every 2 weeks after starting the treatments. Results In the serum and control groups, oozing stopped in 62.5 and 0% of eyes, respectively (P ¼ 0.003), and point-leaks stopped in 27.3 and 18.2%, respectively (P40.9). IOP significantly increased from 10.073.2 (mean7standard deviation) to 11.873.3 mmHg in eyes in which oozing stopped (P ¼ 0.066), and from 11.472.7 to 15.472.3 mmHg in eyes in which a point-leak stopped (P ¼ 0.042). Conclusions Autologous serum application was significantly effective to stop aqueous oozing but not point-leaks. Stopping oozing or point-leaks was significantly associated with an increase in IOP.

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“…Steroids, perfluoropropane, antimetabolites (antifibrotics, mitomycin C, 5FU), and collagen crosslinking inhibitors (β-aminopropionitrile, D-penicillamine) are the commonly used drugs, while releasable/adjustable sutures or suturolysis is the procedures involving the sutures [7][8][9][10][11][12][13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Post-trabeculectomy topical bevacizumab preventing bleb failure: a preliminary study

Bhasker

Saxena

Singh

2012

j ocul biol dis inform

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This study aims to evaluate the efficacy and safety of post-trabeculectomy topical bevacizumab, in preventing bleb failure. A total of 11 females and 12 males were enrolled for the study. After a complete ophthalmic evaluation, the patients underwent trabeculectomy. Full ophthalmic examination was done the next day, which included visual acuity, intraocular pressure (IOP), and bleb morphology. Next, two drops of bevacizumab [0.25 mg (0.01 ml)] were instilled over the wound area with a tuberculin (1 ml) syringe. Pressure was applied at the medial canthus to prevent it from going into the lacrimal passage. Similar postoperative procedures were repeated at 1, 2, 3, and 4 weeks. So in all, five instillations of bevacizumab were completed. Later, the patients were followed at 1-month interval for 6 months. Target IOP was achieved in all eyes and was maintained during the study period of 6 months without any anti-glaucoma medication. Average IOP before trabeculectomy was 27.27±8.92 mmHg, which decreased postoperatively to 8.77±0.97 mmHg at 3 months and 9.27±1.16 mmHg at 6 months. This drop in IOP was statistically significant on both occasions (p=0.00). A nice low filtering bleb was formed after the surgery, and it remained the same during the study period. The other parameters like cup-to-disc ratio and visual field did not change during the 6 months of study as expected because glaucoma is a slow progressive disease. Modulating the wound at multiple sites by bevacizumab (inflammation, proliferative, and remodeling stages) can lead to success of trabeculectomy.

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Glaucoma Filtering Surgery with 5-Fluorouracil

Cited by 207 publications

References 30 publications

Management of Neovascular Glaucoma

Management of Neovascular Glaucoma

Topical application of autologous serum for the treatment of late-onset aqueous oozing or point-leak through filtering bleb

Post-trabeculectomy topical bevacizumab preventing bleb failure: a preliminary study

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