Abstract
Antimetabolites have revolutionized filtration surgery in patients with a high risk of scarring postoperatively. There are many different categories of patients with different healing responses, and these patients may need different degrees of wound modulation. For patients with a high risk of failure due to scarring, intraoperative mitomycin-C (MMC) appears to be superior to 5-fluouracil (5-FU) injections in terms of intraocular pressure (IOP) control, convenience, and corneal side effects. For lower risk patients, weaker intraoperative agents such as 5-FU may be more appropriate. Long-term complications of antimetabolites may include leaking blebs, hypotony with maculopathy, and an increased incidence of endophthalmitis. The rationale behind the choice of antimetabolite and surgical details, including the technique of antimetabolite application, surgical site positioning, conjunctival edge protection, scleral flap, and suture technique are discussed
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