CLINICAL PERSPECTIVES ON GLAUCOMA-FILTERING SURGERY : Antiproliferative Agents - 06/09/11
Résumé |
The goal of glaucoma filtering surgery is to establish a permanent flow of aqueous from the anterior chamber to the subconjunctival space and thereby lower intraocular pressure (IOP) in eyes with uncontrolled glaucoma. Although often successful when performed in previously unoperated eyes with primary open-angle glaucoma, chronic angle-closure glaucoma, and some of the secondary glaucomas (e.g., exfoliative and pigmentary glaucoma), certain risk factors reduce the likelihood of success in glaucoma filtering surgery.74 These risk factors include aphakia or pseudophakia, previously failed filtering surgery, a history of anterior segment neovascularization, severe inflammation, youth, race, and previous medical therapy, especially with cholinergic and sympathomimetic agents.6, 7
Numerous pharmacologic and surgical techniques have been described to improve the outcome in high-risk eyes. In the early 1980s, 5-fluorouracil (5-FU) was introduced as a postoperative adjunct to glaucoma filtering surgery.25 This agent has been clearly shown to increase surgical success not only in high-risk eyes26, 58, 59, 82, 84 but also in primary filtering procedures.40, 50, 86 The use of intraoperative mitomycin was also first reported in the early 1980s.11 In the 1990s, use of this agent as well as intraoperative and postoperative 5-FU became widespread.
This article reviews the background, rationale, and surgical indications for use of the two antiproliferative agents, 5-FU and mitomycin; appropriate operative and perioperative techniques; and management and avoidance of complications associated with their use.
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| Address reprint requests to Gregory L. Skuta, MD, Dean A. McGee Eye Institute, 608 Stanton L. Young Boulevard, Oklahoma City, OK 73104 Supported in part by grants from Research to Prevent Blindness, Inc, New York, New York, and the National Eye Institute (core grant EY12190). |
Vol 13 - N° 3
P. 501-515 - septembre 2000 Retour au numéro
Article précédent
- Molecular Genetics In The Clinical Practice Of Glaucoma
- Eytan Z. Blumenthal, Robert N. Weinreb
- The Failing Filtering Bleb
- Paul Palmberg
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