Sauder G., Jonas J. B.

Department of Ophthalmology, Faculty of Clinical Medicine Mannheim, Ruprecht-Karls- University Heidelberg

Objective: The use of antifibrotics has become part of the standard repertoire of filtrating surgery. They are usually intraoperatively applied by a soaked sponge directly onto the site of surgery. The purpose of the present study was to evaluate whether the antifibrotics can also be injected subconjunctivally.
Patients and Methods: The prospective clinical interventional consecutive case series study included 6 patients who underwent filtrating surgery with the addition of antifibrotics. For all patients, 0.1 ml to 0.3 ml mitomycin C (0.20 mg/ml) were subconjunctivally injected in the 12 o´clock position. Mean follow-up period was 3 months. Main outcome parameters were preoperative and postoperative visual acuity and intraocular pressure, and postoperative intraocular inflammation.
Results: Mean intraocular presssure was reduced from 39.0 ± 15.5 mm Hg (range 24 - 63 mm Hg) preoperatively to 7.8 mm Hg ± 4.76 (range, 5 - 16 mm Hg) postoperatively. Mean visual acuity decreased from 0.3 ± 0.12 (range 0.1 -0.4) to 0.13 ± 0.15 (range, finger counting - 0.4) on the 7th postoperative day. In none of the patients, a marked intraocular inflammation was observed that migt have been due to a leakage of antifibrotics into the eye during surgery.
Conclusions: The preoperative or intraoperative subconjunctival injection of antifibrotics as part of filtrating surgery may be a possibility to deliver antifibrotics. The advantage of the subconjunctival injection compared with the topcal application with a sponge may be that the dosage of antifibrotic applied may better be determined, and that less antifibrotic may spill over the corneal and conjunctival surface.

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