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.<sup>74 Skuta G.L., Parrish R.K. Wound healing in glaucoma filtering surgery Surv Ophthalmol 1987 ;  32 : 149-170  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> 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.<sup>6 Broadway D.C., Grierson I., O'Brien C. , e al. Adverse effects of topical antiglaucoma medication: II. The outcome of filtration surgery Arch Ophthalmol 1994 ;  112 : 446-1454

Cliccare qui per andare alla sezione Riferimenti, 7 Broadway D.C., Grierson I., Sturmer J. , e al. Reversal of topical antiglaucoma medication effects on the conjunctiva Arch Ophthalmol 1996 ;  114 : 262-267

Cliccare qui per andare alla sezione Riferimenti</sup>

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.<sup>25 Heuer D.K., Parrich R.K., Gressel M.G. , e al. 5-Fluorouracil and glaucoma filtering surgery: II. A pilot study Ophthalmology 1984 ;  91 : 385-393

Cliccare qui per andare alla sezione Riferimenti</sup> This agent has been clearly shown to increase surgical success not only in high-risk eyes<sup>26 Heuer D.K., Parrich R.K., Gressel M.G. , e al. 5-Fluorouracil and glaucoma filtering surgery: III. Intermediate follow-up of a pilot study Ophthalmology 1986 ;  93 : 1537-1546

Cliccare qui per andare alla sezione Riferimenti, 58 Rockwood E.J., Parrich R.K., Heuer D.K. , e al. Glaucoma filtering surgery with 5-fluorouracil Ophthalmology 1987 ;  94 : 1071-1078

Cliccare qui per andare alla sezione Riferimenti, 59 Ruderman S.M., Welch D.B., Smith M.F. , e al. A randomized study of 5-fluorouracil and filtration surgery Am J Ophthalmol 1987 ;  104 : 218-224

Cliccare qui per andare alla sezione Riferimenti, 82 The Fluorouracil Filtering Surgery Study Group Fluorouracil filtering surgery study one-year follow-up Am J Ophthalmol 1989 ;  108 : 625-635

Cliccare qui per andare alla sezione Riferimenti, 84 Weinreb R.N. Adjusting the dose of 5-fluorouracil after filtration surgery to minimize side effects Ophthalmology 1987 ;  94 : 564-570

Cliccare qui per andare alla sezione Riferimenti</sup> but also in primary filtering procedures.<sup>40 Liebmann J.M., Ritch R., Marmor M. , e al. Initial 5-fluorouracil trabeculectomy in uncomplicated glaucoma Ophthalmology 1991 ;  98 : 1036-1041

Cliccare qui per andare alla sezione Riferimenti, 50 Ophir A., Ticho U. A randomized study of trabeculectomy and subconjunctival administration of fluorouracil in primary glaucomas Arch Ophthalmol 1992 ;  110 : 1072-1075

Cliccare qui per andare alla sezione Riferimenti, 86 Wilson R.P., Steinmann W.L. Use of trabeculectomy with postoperative 5-fluorouracil in patients requiring extremely low intraocular pressure levels to limit further glaucomatous progression Ophthalmology 1991 ;  98 : 1047-1052

Cliccare qui per andare alla sezione Riferimenti</sup> The use of intraoperative mitomycin was also first reported in the early 1980s.<sup>11 Chen C.-W. Enhanced intraocular pressure controlling effectiveness of trabeculectomy by local application of mitomycin-C Trans Asia-Pacific Acad Ophthalmology 1983 ;  9 : 172-177

Cliccare qui per andare alla sezione Riferimenti</sup> 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.