Do Injections of 5-Fluorouracil After Trabeculectomy Have Toxic Effects on the Anterior Segment?

Abstract

In this study 5-FU did not provoke an intraocular inflammatory response and had minimal effect on extraocular structures. Changes in corneal epithelium and endothelium detectable by confocal microscopy suggest a small toxic effect. These in vivo measurements by confocal microscopy were confirmed by SEM. Repeated administration did not cause additional cumulative toxic effects in the anterior segment. Therefore, multiple injections of 5- FU into the filtering bleb pose minimal risk to intraocular structures.

Mechanism of 5-Fluorouracil-Induced Apoptosis on Cultured Corneal Endothelial Cells

“…In cases of the 5-FU accidentally penetrating into the anterior chamber of the eye, the drug may damage corneal endothelial cells and impair physiological functions such as the pumping activity in the corneal endothelium. In a rabbit model, evidence was presented that 5-FU (50 mg/ml) injected at the trabeculectomy site every five days for 15 days had the deleterious effects on corneal endothelial cells based on observations with confocal microscopy and scanning electron microscopy [8].…”

Ophthalmic drug-loaded N,O-carboxymethyl chitosan hydrogels: synthesis, in vitro and in vivo evaluation

“…Recently, bevacizumab (Avastin), a synthetic monoclonal antibody against vascular endothelial growth factor (anti-VEGF), was reported to limit scar formation after glaucoma filtration surgery and effectively decreased IOP of patients [4,7,8] . However, multiple subconjunctival injections of 5FU or bevacizumab after surgery are required to maintain a high drug concentration [4,9,10] . This process is usually associated with several undesirable complications such as conjunctival wound leaks, corneal epithelial defects, endophthalmitis, cataracts and other ocular diseases [6] .…”

After-cataract evaluation after using balanced salt solution, distilled deionized water, and 5-fluorouracil with a sealed-capsule irrigation device in the eyes of 4-week-old rabbits

“…Repeated injections at the trabeculectomy site have little effect on intraocular structures. 22 An in vitro study of bovine endothelial cells confirms this finding. 23 In addition, the antimetabolite does not seem to be dangerous to the retina.…”