1Jordan J. F., 1Diestelhorst M., 2Grisanti S.

1University Eye Clinic Cologne, Joseph-Stelzmann-Str.9, 50931 Cologne; 2University Eye Clinic Tübingen, Schleichstr. 12-16, 72076 Tübingen, Germany

Purpose: BCECF-AM [2,7,-bis- (2-carboxyethyl) -5- (and-6) -carboxyfluorescein, acetoxymethyl-ester] is a cell-membrane permeable compound, rendered membrane-impermeable and fluorescent upon cleavage by intracellular esterases. The present study was designed to investigate the safety and efficacy of photodynamic therapy (PDT) to control postoperative fibrosis after glaucoma surgery.
Methods: Prior to trabeculectomy 26 consecutive eyes of 25 glaucomapatients received a subconjunctival injection of 80µg BCECF-AM followed by an intra-operative illumination with blue light (450-490 nm) for 8 minutes. Antifibrotic efficacy was established as IOP reduction from baseline and by slitlamp-examination. Success was defined as an IOP reduction of >20%, and IOP < 21 mmHg without glaucoma medication.
Results: Eyes had mean 1.3 preoperative surgical interventions. Mean preoperative IOP was 34.4 ± 10.5 mmHg. After mean 359 days follow-up IOP decreased significantly (p<0.001; t-test) in 14 eyes to 15.9 ± 3.8 mmHg without medication. 7 eyes failed due to scarring within 2 to 67 weeks. 5 eyes showed good IOP reduction under topical antiglaucomatous medication. Clinical follow-up examinations revealed no toxic effect, no endophthalmitis, no uveitis.
Conclusions: Our method is an alternative approach to control wound modulation in human eyes undergoing glaucoma surgery. In contrast to Mitomycin C cellular photoablation acts only on cells having incorporated the dye and being exposed to light at an appropriate wavelength. The data of the first human eyes combining trabeculectomy with PDT underline the safety and efficacy of this method.

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