Abstract Objectives: To determine whether there is increased risk to the corneal endothelium when mitomycin C is used in trabeculectomy surgery instead of fluorouracil, and whether these agents play a role in accelerating cataract formation. Design, Settings, and Participants: We analyzed the corneal endothelium and the lens preoperatively and post-operatively in 30 eyes of 21 patients who underwent either a fluorouracil- or mitomycin C-supplemented trabeculectomy. Results: No significant differences were found between these two groups in the rate of cataract progression, magnitude of endothelial cell loss, or appearance of endothelial cell morphologic characteristics. Endothelial cell loss accounted for approximately 7% to 8% of the preoperative counts in both groups. In addition, four (27%) of 15 eyes in each group showed evidence of cataract progression as graded by the Lens Opacities Classification System II. Conclusion: Fluorouracil- and mitomycin C-supplemented trabeculectomies cause similar changes in the lens and corneal endothelium. References 1. Chen CW, Huang HT, Bair JS, Lee CC. Trabeculectomy with simultaneous topical application of mitomycin-C in refractory glaucoma . J Ocul Pharmacol . 1990;6:175-182.Crossref 2. Palmer SS. Mitomycin as adjunct chemotherapy with trabeculectomy . Ophthalmology . 1991;98:317-321.Crossref 3. Pasquale LR, Thibault D, Dorman PM, Quigley HA, Jampel HD. Effect of topical mitomycin C on glaucoma filtration surgery in monkeys . Ophthalmology . 1992;99:14-18.Crossref 4. Wilson MR. Posterior lip sclerectomy vs trabeculectomy in West Indian blacks . Arch Ophthalmol . 1989;107:1604-1608.Crossref 5. Pappa KS, Derick RJ, Weber PA, Kapetansky FM, Baker ND, Lehmann DM. Late argon laser suture lysis after mitomycin C trabeculectomy . Ophthalmology . 1993;100:1268-1271.Crossref 6. Derick RJ, Pasquale L, Quigley HA, Jampel H. Potential toxicity of mitomycin C . Arch Ophthalmol . 1991;109:1635.Crossref 7. Pastor SA, Williams RD, Hetherington J, Hoskins HD, Goodman D. Corneal endothelial cell loss following trabeculectomy with mitomycin C . J Glaucoma . 1993;2:112-114. 8. McDermott ML, Wang J, Shin DH. Mitomycin and the human corneal endothelium . Arch Ophthalmol . 1994;112:533-537.Crossref 9. Mayer DJ. Clinical Wide-Field Specular Microscopy . London, England: Bailliere Tindall; 1984:18-27. 10. Chylack LT, Leske C, McCarthy D, Khu P, Kashiwagi T, Sperduto R. Lens Opacities Classification System II (LOCSII) . Arch Ophthalmol . 1989;107:991-997.Crossref 11. Kitazawa Y, Kawase K, Matsushita H, Minobe M. Trabeculectomy with mitomycin . Arch Ophthalmol . 1991;109:1693-1698.Crossref 12. Skuta GL, Beeson CC, Higginbotham EJ, et al. Intraoperative mitomycin versus postoperative 5-fluorouracil in high-risk glaucoma-filtering surgery . Ophthalmology . 1992;99:438-444.Crossref 13. Fiore PM, Richter CU, Arzeno G, et al. The effect of anterior chamber depth on endothelial cell count after filtration surgery . Arch Ophthalmol . 1989;107:1609-1611.Crossref 14. Korye M, Gieser D, Kass MA, Waltman SR, Gordon M, Becker B. Central endothelial cell density and central corneal thickness in ocular hypertension and primary open-angle glaucoma . Am J Ophthalmol . 1982;94:610-616. 15. Olsen T. The endothelial cell damage in acute glaucoma . Acta Ophthalmol (Copenh) . 1980;58:257-266.Crossref 16. Setala K. Corneal endothelail cell density after an attack of acute glaucoma . Acta Ophthalmol (Copenh) . 1979;57:1004-1013.Crossref 17. Smith D, Skuta G, Lindenmuth K, Musch D, Bergstrom T. The effect of glaucoma filtering surgery on corneal endothelial cell density . Ophthalmic Surg . 1991;22:251-255. 18. Asamoto A, Yablonski ME. Posttrabeculectomy anterior subcapsular cataract formation induced by anterior chamber air . Ophthalmic Surg . 1993;24:314-319. 19. Chauvaud D, Clay FC, Pouliquen Y, Offret G. Opacification of the crystalline lens after trabeculectomy . Arch Ophthalmol Rev Gen Ophthalmol . 1976;36:379-386. 20. Clarke MP, Vernon SA, Sheldrick JH. The development of cataract following trabeculectomy . Eye . 1990;4:577-583.Crossref 21. Kuppens EVMJ, van Best JA, Boets EPM, Sterk CC. Lens autofluorescence and lens transmission in glaucoma and ocular hypertension . Invest Ophthalmol Vis Sci . 1994;35:2795.
Archives of Ophthalmology – American Medical Association
Published: May 1, 1995
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