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The Impact of Photodynamic Therapy in Glaucoma Filtration Surgery
1Grisanti S., 2Jordan J. F.,
1Eberhard-Karls-Universität Tübingen, Universitäts-Augenklinik (Tübingen)
2Universität zu Köln, Zentrum für Augenheilkunde (Köln)
Trabeculectomy is the most frequently applied surgical method to reduce intraocular pressure in patients with glaucoma. The wound healing process at the site of the filtration area, however, is causative for surgery failure. To increase the success rates of filtering surgery, antimetabolites like Mitomycin-C and 5-Fluouracil have been used perioperatively as an antifibrotic therapy. Despite their positive effect on filtering surgery success rates in cases with poor surgical prognosis, diffusion into adjacent ocular tissues caused toxic effects on others than the targeted cells. Photodynamic therapy is an alternative approach that should avoid this problem. Selective activation of a photosensitizer by light application at an appropriate wave-length limits the drug effect to a selective area. BCECF-AM (2'7'-bis-(2-carboxyethyl)-5-(and-6)-carboxyfluorescein, acetoxy-methyl-ester) is such a photosensitizer. Due to its characteristics it can be used as an antifibrotic agent in glaucoma filtration surgery. BCECF-AM is a cell membrane permeable compound rendered membrane-impermeable and fluorescent upon cleavage by intracellular esterases(1-3). Exposure of cells having incorporated BCECF-AM to light at an appropriate wavelength leads to cellular photoablation. This review examines the applicability and safety of photodynamic therapy in glaucoma filtration surgery. Finally, it compares the first clinical results with the effect obtained by the use of antimetabolites and the more recent approach with neutralising antibodies to the growth factor TGF-ß.