Late Complications After Glaucoma Filtering Surgery With Adjunctive 5-Fluorouracil

Combined trabeculotomy and trabeculectomy: outcome for primary congenital glaucoma in a West African population

“…Second, it is a known fact that the use of trabeculectomy without anti-metabolites in adults with glaucoma of African descent is associated with poor outcome, 22,23 a fact that is also demonstrated in adult Ghanaians, 23,24 suggesting a possibility of failure in children of same racial descent. These facts, coupled with the poor result of trabeculectomy in children because of the aggressive wound-healing response, presence of a thick Tenon's capsule and low scleral rigidity, 25 the mild to serious ocular complications that tend to be associated with adjunctive anti-fibrotic drug use, even though the latter on the average improves trabeculectomy outcome, [25][26][27][28][29] all informed our quest to try the CTT alone as an alternate procedure.…”

Free conjunctival grafts in the repair of leaking filtering blebs

“…Their recognition, often presented by increased tearing, marked hypotony and a positive leak demonstrated by 2% fluorescein, is very important in glaucoma management (8) . Ischemic, thin-walled blebs are more likely to develop after full-thickness filtration surgeries (6)(7)(8) or trabeculectomies with adjunctive use of antimetabolities (1)(2)(3)(4)8,10) , particulary mitomycin C (17) , and are also more susceptible to rupture and present late leakage than thicker blebs (1)(2)(6)(7) . Antimetabolites have been shown to contribute to leaks that may come from different sites and different times and are associated with conjunctival epithelial breakdown and stromal degeneration (18) .…”

“…The growing popularity of antimetabolites such as 5-fluoracil (5-FU) and mitomycin-C (MMC) during or immediately after the filtrating procedures has improved the success of surgery but the occurrence of thin, ischemic blebs after trabeculectomy has also become common (1)(2)(3) . It is known that 5-fluorouracil and MMC inhibit fibroblast proliferation that result in thinner, more fragile blebs (4) .…”

“…It is known that 5-fluorouracil and MMC inhibit fibroblast proliferation that result in thinner, more fragile blebs (4) . Bleb leaks can occur months to years after filtrating surgery (4)(5)(6) , and ischemic, thin-walled blebs are more susceptible to leakage than thicker blebs (1,2,(6)(7) . Chronic bleb leaks may predispose the eye to endophthalmitis, hypotony, flat anterior chamber, peripheral anterior synechia, corneal decompensation, macular edema, blebitis and choroidal detachment.…”

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

“…[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. 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.…”