Using 5-FluorouraciI With Glaucoma Filtering Surgery

Abstract

N EYES WITH glaucoma, failure of filtering I surgery may be related to internal and external events. In the former situation, intraocular tissue, including iris, ciliary body, lens, or vitreous, may become incarcerated in the scleral fistula. Further, a pigmented or nonpigmented membrane may develop on occasion and may occlude the internal sclerostomy opening. However, the most common mechanism of filtration failure is extraocular episcleral fibrocellular proliferation.’,’ In eyes with otherwise poor surgical prognosis, subconjunctival injections of 5-fluorouracil during the first two postoperative weeks appear to inhibit fibroproliferation and increase the likelihood of successful filtration.3” However, this antimetabolite has the potential to inhibit other actively replicating cells during this period, particularly corneal and conjunctival epitheli~m.~.’ We have found it beneficial to modify our surgical technique when using this potent antimetabolite to minimize potential complications. PREOPERATIVE EVALUATION Preoperatively, proper case selection plays an important part in the avoidance of possible complications. Reported severe corneal complications associated with the use of 5-fluorouracil, ie, sterile, herpetic, bacterial, and fungal ulceration, have occurred in the setting of nonresolving persistent epithelial defects, particularly when topical steroids were being administe~ed.~.’ Problems with epithelial healing usually have occurred within the first few weeks of surgery, although microbial keratitis has occurred in some patients several months after surgery. In these cases, it has been our experience that there is a preponderance of eyes with abnormal lid function, lid apposition, or corneal and conjunctival disease. A thorough evaluation