Antiproliferative surgery: Intraoperative mitomycin C versus postoperative 5-fluorouracil

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Abstract

The focus of glaucoma filtering surgery has evolved from the surgical aspects of fistulization to the alteration of postoperative wound healing. Intraoperative application of mitomycin C is generally accepted as an alternative to postoperative subconjunctival injection of 5-fluorouracil (5-FU) in patients with a poor prognosis. Early reports suggest that both agents have comparable effects in the management of refractory glaucoma with trabeculectomy. Although they alter wound healing, serious short- and long-term complications have been described with both drugs, including exuberant bleb formation and prolonged hypotony associated with macular folds and decreased visual acuity. Indiscriminate use of either drug in highly myopic eyes therefore appears inadvisable. The onset of wound leaks months to years after filtering surgery and the risk of associated bacterial endophthalmitis after conjunctivitis pose real threats to long-term visual function. The catastrophic complications associated with multiple applications of topical mitomycin after pterygia excision have not been reported following a single intraoperative application in filtering surgery. Complications of short-term corneal epithelial toxicity and conjunctival wound leaks, which are common with multiple injections of 5-FU following filtering surgery, have been substantially reduced by decreasing the total number of injections from twice-daily injections during the first postoperative week and once-daily during days 8 to 14 (total dose, 105 mg) to once-daily injections for the first week (total dose, 50 mg). Although intraoperative mitomycin is more convenient and easier to use than subconjunctival 5-FU, these agents may have comparable effects on the incidence of serious long-term complications, such as bleb-related endophthalmitis.

Original languageEnglish
Pages (from-to)76-85
Number of pages10
JournalChibret International Journal of Ophthalmology
Volume10
Issue number3
StatePublished - Jan 1 1994

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Filtering Surgery
Mitomycin
Fluorouracil
Injections
Endophthalmitis
Blister
Glaucoma
Wound Healing
Pterygium
Trabeculectomy
Conjunctivitis
Wounds and Injuries
Pharmaceutical Preparations
Visual Acuity
Incidence

ASJC Scopus subject areas

  • Ophthalmology

Cite this

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title = "Antiproliferative surgery: Intraoperative mitomycin C versus postoperative 5-fluorouracil",
abstract = "The focus of glaucoma filtering surgery has evolved from the surgical aspects of fistulization to the alteration of postoperative wound healing. Intraoperative application of mitomycin C is generally accepted as an alternative to postoperative subconjunctival injection of 5-fluorouracil (5-FU) in patients with a poor prognosis. Early reports suggest that both agents have comparable effects in the management of refractory glaucoma with trabeculectomy. Although they alter wound healing, serious short- and long-term complications have been described with both drugs, including exuberant bleb formation and prolonged hypotony associated with macular folds and decreased visual acuity. Indiscriminate use of either drug in highly myopic eyes therefore appears inadvisable. The onset of wound leaks months to years after filtering surgery and the risk of associated bacterial endophthalmitis after conjunctivitis pose real threats to long-term visual function. The catastrophic complications associated with multiple applications of topical mitomycin after pterygia excision have not been reported following a single intraoperative application in filtering surgery. Complications of short-term corneal epithelial toxicity and conjunctival wound leaks, which are common with multiple injections of 5-FU following filtering surgery, have been substantially reduced by decreasing the total number of injections from twice-daily injections during the first postoperative week and once-daily during days 8 to 14 (total dose, 105 mg) to once-daily injections for the first week (total dose, 50 mg). Although intraoperative mitomycin is more convenient and easier to use than subconjunctival 5-FU, these agents may have comparable effects on the incidence of serious long-term complications, such as bleb-related endophthalmitis.",
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