terminology and guidelines for glaucoma ii - Kwaliteitskoepel

Post-operative use
Concentration: 0.2 mg/ml
0.02 mg injections.
Small calibre needle (e.g. 30 G needle on insulin syringe)
Adjacent to but not into bleb
Multiple injections possible - some evidence that less than a total of 3 injections
has a minimal impact
GENERAL PRINCIPLES
The use of cytotoxics increases the requirement for accurate surgery. If aqueous flow is not well controlled persistent
hypotony will occur. Strategies to increase control of flow include smaller sclerostomies, larger scleral flaps and releaseable
or adjustable sutures.
Recent research has suggested that a large surface area of cytotoxic treatment together with large scleral flaps and
fornix based conjunctival flaps leads to diffuse, posteriorly extended non-cystic blebs with a considerable reduction
in bleb related complications such as blebitis and endophthalmitis 160-161 .
Start with weaker agents (e.g. 5-FU rather than MMC) and lower concentrations (of MMC) until familiar with these
agents
CAUTION
Do not allow cytotoxic agents to enter the eye. 5-FU has a pH of 9.0. One drop (0.05ml) of MMC would cause irreversible
endothelial damage.
Observe precautions for cytotoxic use and disposal
Complications:
Corneal epitheliopathy (5FU)
Wound Leak
Bleb leak
Hypotony
Blebitis
Endophthalmitis
IMPORTANT: assess each individual case for risk factors, and/or for the need of low target IOP and titrate the substance
and dosage used accordingly based on local experience
5-FU and MMC are not officially approved for direct ocular applications. Their use in
selected cases as adjunctives in filtration surgery, however, has become standard clinical practice.
Ch. 3 - 38 EGS