The corneal endothelial abnormalities after SLT shown in this study may be transient, and long-term effects are probably negligible in normal corneas or single treatments. However, in corneas with reduced transparency of the endothelium, such as compromised corneas and corneas with pigment deposits on the endothelium, there may be a risk of further corneal endothelial compromise, especially after repeated SLT. Larger and longer term studies with histopathologic evaluation would be useful to evaluate the effect of SLT on normal and subnormal corneal endothelium. Until further studies are done, it would be wise to minimize the number and energy of SLT laser shots.
The effect of selective laser trabeculoplasty on the corneal endothelium may be transient, and long-term effects are probably negligible in normal corneas. However, in compromised corneas and corneas with pigment deposits on endothelium, there may be a risk of corneal endothelial compromise, especially after repeated selective laser trabeculoplasty. Larger and longer term studies with histopathological evaluation would be useful to evaluate the effect of selective laser trabeculoplasty on normal and subnormal corneal endothelium. Until further studies are done, it would be wise to minimize the number and energy of laser shots.
Purpose: Subconjunctival fibrosis is one of the main causes of failure of glaucoma filtration surgery. It can result in absence of a filtration bleb, a small scarred bleb, or a cystic bleb. 5-Fluorouracil (5-FU), mitomycin C (MMC), and topical steroids have been used to suppress subconjunctival fibrosis.
Method: A study was done analyzing the number of postoperative subconjunctival 5-FU injections for trabeculectomy on pseudophakic eyes prior to and following the change to a BAK-free regimen. The cohort consisted of 16 consecutive cases undergoing primary trabeculectomy without intraoperative MMC or 5-FU. The trabeculectomy surgery included a groove sclerectomy procedure. Group A were 8 eyes of patients who had the author’s standard Chlorsig, Maxidex, and Prednefrin Forte eye drops tds. Group B were 8 eyes who had Chlorsig-dexamethasone and Optive-dexamethasone tds eye drops postoperatively.
Results: Group B (BAK-free) patients required fewer postoperative 5-FU subconjunctival injections (average: 2.9, range: 1-5 injections) compared to Group A (BAK) patients (average: 7.3, range: 4-18 injections). This difference was statistically significant (P = 0.02, unpaired t-test). All patients had functioning blebs and did not require glaucoma medications to maintain target intraocular pressure. The Group B (BAK-free) patients had more diffuse blebs than the Group A (BAK) patients.
Conclusion: The results demonstrated that when BAK was eliminated from postoperative eye drops in trabeculectomy, the number of postoperative 5-FU injections was reduced.
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