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Complications of Filtering Surgery using Antimetabolites
Department of Ophthalmology, University of Cologne, Cologne, Germany
Complications related to the use of antimetabolites occur depending on the kind of the substance used and the way of application. The specific risk profile of the drugs influences the situations in which these substances may be used.
Antimetabolites may be used not only for trabeculectomy, but merely for all glaucoma procedures where wound healing is an issue. Specific complications can occur during surgery, in the early post-operative period and late after surgery.
During surgery, the uncontrolled exposure of the adjacent tissue should be avoided, and the substances should not get directly intraocularly. The margins of the incised conjunctiva should not be exposed, because healing problems may develop.
In the early post-operative period, hypotony is a relevant issue. Increased filtration may also develop without the use of antimetabolites, but this usually regresses within a short time. Chronic hypotony may lead to maculopathy with a decrease of the visual acuity. Additionally, choroidal effusion, flat anterior chambers and anterior synechiae may develop. A severe hypotony should be treated immediately.
During the late post-operative time period, infections become more important such as blebitis or endophthalmitis as a consequence of largely avascular filtering blebs.
In many cases, the use of antimetabolites can not be avoided and a surgical success can not be achieved without their use. The surgeon should try to use a standar
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