Antiproliferative therapy with 5-fluorouracil in erbium:YAG laser sclerostomy ab externo

Abstract

Erbium laser sclerostomy (ELS) ab externo is a minimally invasive addition to conventional fistulating glaucoma surgery. To date, the success rate of this method is lower than that of trabeculectomy or goniotrepanation. The chief cause of therapy failure is postoperative episcleral scarring of the bleb. It was the aim of the present study to decrease the occlusion rate of this complication. 41 eyes were treated with subconjunctival injections of 5-fluorouracil perioperatively to an intended total dose of 40 mg to prevent episcleral scarring. At the same time, bigger probe diameters were used (550 microns and 700 microns instead of 300 microns). After 3 months, the proportion of patients with regulated intraocular pressure after using bigger probe diameters combined with anti-proliferative therapy was significantly higher (550 microns fiber +5-FU: 73%; 700 microns fiber +5-FU: 71%) than for a 300 microns fiber without 5-FU (38%). Average intraocular pressure in successful cases was 11.6 +/- 4.2 mmHg in the 550 microns fiber +5-FU group and 12.3 +/- 4.0 mmHg in the 700 microns fiber +5-FU group. The short-term results of erbium laser sclerostomy as a minimally invasive technique can be improved by using increasing laser fiber diameters and by perioperative injections of 5-FU to prevent episcleral fibrosis.