Intraoperative mitomycin versus postoperative 5-fluorouracil in high-risk glaucoma filtering surgery.

In a randomized clinical trial, the authors compared the use of postoperative subconjunctival injections of 5-fluorouracil (5-FU) in 19 eyes with a single intraoperative application of subconjunctival mitomycin (MMC) at the filtering site in 20 eyes at high risk for failure of glaucoma filtering surgery. Six months after surgery, intraocular pressures averaged 10.9 +/- 5.3 mmHg (mean +/- standard deviation) in the MMC-treated eyes versus 14.2 +/- 5.5 mmHg in the 5-FU-treated eyes (P = 0.08) and were less than or equal to 12 mmHg in 60.0% of MMC-treated eyes and 21.1% of 5-FU-treated eyes (P = 0.03). Mitomycin-treated eyes were receiving an average of 0.3 +/- 0.5 medications for intraocular pressure control, and 5-FU-treated eyes were receiving an average of 1.1 +/- 1.1 medications (P = 0.01). Drug-induced corneal epithelial defects were seen in nine 5-FU-treated eyes and in no MMC-treated eyes (P = 0.0004). These results suggest that intraoperative MMC may be a viable alternative to postoperative 5-FU, with lower overall intraocular pressures, decreased dependence on postoperative ocular antihypertensive medications, and decreased corneal toxicity.

Visual acuity prediction before neodymium-YAG laser posterior capsulotomy.

A laser interferometer (Retinometer) and the Potential Acuity Meter (PAM) was used to assess macular function before neodymium-YAG laser posterior capsulotomy in 40 patients. Although specificity was excellent with the PAM (91%) and Retinometer (93%), sensitivity was limited to 42% and 33%, respectively. Diffuse posterior capsular opacification which precluded the delivery of light through a clear portion of the capsule was the most likely cause of the high false negative rate. A positive result on either test has good predictive value, reducing the changes of the capsulotomy being a failure by fourfold.