Intraoperative use of antimetabolites in glaucoma surgery

Glaucoma is the main cause of irreversible blindness worldwide, the treatment of which is based on reducing intraocular pressure to tolerant values. Despite the development of medication and laser methods, surgery remains the most effective means of glaucoma treatment, while trabeculectomy remains the golden standard of surgery. However, postoperative scarring remains a critical determinant of long-term bleb survival and IOP control after drainage surgery. Antimetabolites, such as mitomycin C and 5-fluorouracil, have been used to increase the survival time of filtration surgeries by preventing bleb fibrosis and scarring. Mitomycin C is activated via enzymatic reduction into metabolites that inhibit cell replication by inhibiting DNA synthesis, RNA transcription, and protein synthesis. In tissue culture, MMC induces apoptosis of tenon fibroblasts. MMC blocks cell division, which in turn inhibits fibroblast proliferation and enhances bleb formation and function.

This review includes a literature analysis on the use of antimetabolites in glaucoma surgery. Based on the data and literary sources of recent years, a general understanding of the mechanism of action of MMS and the need for its use in the course of AGO, but exclusively with low doses and short exposure times, has been achieved, which will reduce the frequency of complications associated with excessive filtration, but at the same time prevent the development of excessive scarring.

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