Long-term effects of mitomycin on filtering blebs. Lack of fibrovascular proliferative response following severe inflammation
M. K. Yaldo and R. L. Stamper
Department of Ophthalmology, California Pacific Medical Center, San Francisco 94115.
BACKGROUND AND OBJECTIVE--The use of antimetabolites, such as fluorouracil
and mitomycin, enhances the success rate of filtering surgery, especially
in eyes at high risk for failure, and increases the likelihood of a thin,
avascular filtering bleb. In addition, mitomycin may cause long-term
inhibition of the fibroblast's ability to proliferate in the conjunctiva
and Tenon's capsule. Preoperative and postoperative inflammation frequently
contributes to scarring of filtering blebs. The purpose of this study is to
evaluate the effect of intraoperative mitomycin use on the survival of
filtering blebs after severe inflammation. DESIGN--We retrospectively
studied three eyes that had undergone trabeculectomy with intraoperative
mitomycin. Two eyes had concomitant intraocular lens implantation. All
three eyes had blebs that functioned well postoperatively. PATIENTS--These
eyes sustained episodes of intense inflammation in the form of herpes
zoster ophthalmicus, endophthalmitis, or purulent infection of the bleb
postoperatively. RESULTS--Following treatment of the inflammation, no
change in the appearance or function of the bleb could be detected.
CONCLUSION--Either the indirect effect of mitomycin in producing a thin,
avascular bleb or a long-term effect of mitomycin on the ability of
conjunctival and Tenon's capsule fibroblasts to proliferate may have
contributed to bleb survival.
