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Glaucoma Filtration Surgery with Photodynamic Therapy to Modulate Postoperative Wound-healing Update of a Clinical Pilot Study
1Jordan J. F., 1Diestelhorst M., 2Grisanti S., 1Krieglstein G. K.,
1Universität zu Köln, Zentrum für Augenheilkunde (Köln)
2Eberhard-Karls-Universität Tübingen, Universitäts-Augenklinik (Tübingen)
Purpose: The study was designed to investigate the safety and efficacy of photodynamic therapy (PDT) to control postoperative fibrosis following glaucoma filtration surgery.
Methods: BCECF-AM (carboxyfluorescein) is a cell-membrane permeable compound, rendered membrane-impermeable and fluorescent upon cleavage by intracellular esterases. Prior to trabeculectomy (TE), 42 consecutive eyes of 36 glaucoma patients received a subconjunctival injection of 80µg BCECF-AM in the region of the later filtering blep. This was followed by an intra-operative, focal illumination with blue light (450-490 nm) for 8 minutes to activate the photooxidative effect of intracellular carboxyfluorescein. Success was defined as an IOP reduction of >20% and IOP constantly < 21 mmHg without any glaucoma medication. Antifibrotic efficacy was established as IOP reduction from baseline and by slitlamp examination.
Results: Eyes had mean 1.1 preoperative surgical interventions. Mean preoperative IOP was 31.6 ± 9.7 mmHg. After mean 433 days follow-up (range: 0.5 - 33 months) IOP decreased significantly in 24 eyes to 15.7 ± 3.4 mmHg without medication (57.1%; p<0.001; t-test). 8 eyes showed good IOP reduction under topical antiglaucomatous medication (19.1%). 10 eyes failed due to scarring within 2 to 67 weeks (23.8%). Clinical follow-up examinations revealed no toxic effect, no blebitis, no uveitis, no endophthalmitis.
Conclusions: Combination of trabeculectomy and photodynamic therapy is an alternative approach to control postoperative wound healing after glaucoma surgery. Our data of the first human eyes combining TE with PDT underline the safety and efficacy of this new method.