First Author: A.Rey SPAIN
Co Author(s): E. Milla S. Duch O. Buchacra O. Stirbu
Purpose:
Postoperative bleb needling with 5-fluorouracil for failed filtering blebs may be successful in controlling the intraocular pressure (IOP), but can also cause serious corneal complications. This case reports an adverse effect of 5-FU ocurring in a patient with open angle glaucoma who underwent a non-penetrating deep sclerectomy.
Setting:
Institut Comtal d'Oftalmologia (ICO). Department of Ophthalmology. Barcelona.
Methods:
A 64-year old woman with high axial myopia (15 diopters) and a 10 year history of open angle glaucoma underwent a non-penetrating deep sclerectomy to lower raised IOP in the right eye. 4 subconjunctival injections of 5-FU were indicated because of an encapsulated filtering bleb. Two days after the subconjunctival injections of 5-FU, a central corneal epithelial defect was noted and no further 5-FU was given. The epithelial defect fail to heal despite intensive therapy with lubricants, then a contact lens was inserted into the eye.
Results:
The patient subsequently presented with reduced visual acuity in the right eye to counting fingers, associated with intense pain. Examination revealed an epithelial defect with stromal infiltration and satellite lesions. Bacterial cultures were negative and there was not a good response to vancomycin and ceftazidime, therefore a fungal keratitis was suspected and treated with topical amphotericin effectively. At the last visit visual acuity was 20/40 and IOP was normal.
Conclusions:
The use of antimetabolites has revolutionized glaucoma surgery but unwanted side effects still occur. The success of filtering surgery in eyes with poor prognosis can be improved by 5-FU, but it is known to be potentially toxic to corneal epithelium with a subsequent risk of atypical infectious keratitis. FINANCIAL DISCLOSURE?: No
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