Reinhard T, Klüppel M, Sundmacher R
Augenklinik, Heinrich-Heine-Universität Düsseldorf.
Klin Monbl Augenheilkd. 1993 Nov;203(5):329-35. doi: 10.1055/s-2008-1045686.
Since 1984 subconjunctival 5-Fluorouracil injections have been applied with success after filtering surgery. It was the purpose of this retrospective study to find out whether the results justify this treatment in view of all side effects.
Between 2/1991 and 1/1993 twenty-nine eyes of 11 female and 16 male patients with high-risk glaucoma (unsuccessful previous filtering surgery and a high risk of scarring) were treated with subconjunctival injections of 5-Fluorouracil after filtering surgery in the University Eye Hospital Düsseldorf. The mean age of the patients was 58 (11-84) years and the mean follow-up period was 16 (4-24) months. The mean amount of injected 5-Fluorouracil was 43 (5-85) mg. Glaucoma was regarded as controlled when intraocular pressure levels were reduced by more than 20% of the preoperative level and stayed consistently below 21 mm Hg.
26 (89.6%) of the eyes had controlled intraocular pressure during the follow-up period. Two eyes were controlled only after additional cyclocrycoagulation, and 1 glaucoma has remained uncontrolled. Postoperatively we observed fistulas of the conjunctiva in 24% of the eyes and 69% of the eyes had corneal epithelial breakdown problems. It is unlikely that subconjunctival injections of 5-Fluorouracil work only by inhibiting scarring of the filtration bleb. Long-lasting e-vacuo-symptoms in single cases with no functioning bleb at all as well as scarred blebs in 9 of 26 eyes with controlled glaucoma must be interpreted as a probable sign of 5-Fluorouracil toxicity on the ciliary epithelium.
Subconjunctival injections of 5-Fluorouracil after filtering surgery are helpful to control high-risk glaucoma, but there are several disadvantages of this treatment as fistulas of the conjunctiva, corneal surface problems, discomfort for the patient, difficult follow-up and a potential toxicity on the ciliary epithelium that may be pronounced in some cases. Therefore, subconjunctival injections of 5-Fluorouracil after filtering surgery are a useful means for eyes with a high risk of scarring. However, 5-Fluorouracil should not be applied for primary normal glaucoma surgery.
自1984年以来，结膜下注射5-氟尿嘧啶已成功应用于滤过性手术后。这项回顾性研究的目的是，鉴于所有副作用，确定这些结果是否能证明这种治疗方法的合理性。
1991年2月至1993年1月期间，在杜塞尔多夫大学眼科医院，对11名女性和16名男性高危青光眼患者（既往滤过性手术失败且瘢痕形成风险高）的29只眼睛在滤过性手术后进行了结膜下注射5-氟尿嘧啶治疗。患者的平均年龄为58岁（11 - 84岁），平均随访期为16个月（4 - 24个月）。5-氟尿嘧啶的平均注射量为43毫克（5 - 85毫克）。当眼压水平降低超过术前水平的20%且持续低于21毫米汞柱时，青光眼被视为得到控制。
26只（89.6%）眼睛在随访期间眼压得到控制。2只眼睛仅在额外进行睫状体冷凝术后眼压得到控制，1只青光眼仍未得到控制。术后，我们观察到24%的眼睛出现结膜瘘，69%的眼睛存在角膜上皮破损问题。结膜下注射5-氟尿嘧啶不太可能仅通过抑制滤过泡瘢痕形成起作用。在个别完全没有功能滤过泡的病例中出现的长期真空症状，以及在26只眼压得到控制的眼睛中有9只出现滤过泡瘢痕化，这必须被解释为5-氟尿嘧啶对睫状体上皮毒性的可能迹象。
滤过性手术后结膜下注射5-氟尿嘧啶有助于控制高危青光眼，但这种治疗方法有几个缺点，如结膜瘘、角膜表面问题、患者不适、随访困难以及对睫状体上皮的潜在毒性，在某些情况下可能很明显。因此，滤过性手术后结膜下注射5-氟尿嘧啶是瘢痕形成风险高的眼睛的一种有用方法。然而，5-氟尿嘧啶不应应用于原发性正常青光眼手术。
