Delayed corneal epitheliopathy after antimetabolite-augmented trabeculectomy.
OBJECTIVE
The authors describe the first case of delayed antimetabolite-related corneal epithelial toxicity after trabeculectomy and its successful treatment with limbal stem cell transplantation.


METHODS
A 73-year-old woman underwent trabeculectomy with intraoperative mitomycin C. After surgery she received six 5-mg injections of subconjunctival 5-fluorouracil (5-FU) adjacent to the bleb.


RESULTS
The patient had a functioning trabeculectomy and clear cornea until 30 months after surgery, at which time she developed a nonhealing superior corneal epithelial defect. After 4 months of conservative medical management, an autologous limbal stem cell transplantation was performed. The epithelial defect resolved completely within 1 week of limbal stem cell transplantation.


CONCLUSIONS
Delayed corneal epithelial toxicity may be a late complication of antimetabolite-augmented trabeculectomy.
Department of Ophthalmology, Stanford University School of Medicine, California, USA.
E E
EE
Manche
M A
MA
Afshari
K
K
Singh
D000368:Aged; D000963:Antimetabolites / Q000009:adverse effects* / Q000627:therapeutic use; D003315:Cornea / Q000473:pathology / Q000601:surgery; D003316:Corneal Diseases / Q000139:chemically induced* / Q000473:pathology; D004848:Epithelium / Q000473:pathology; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D016685:Mitomycin / Q000627:therapeutic use; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation; D033581:Stem Cell Transplantation; D013997:Time Factors; D014130:Trabeculectomy
D000963:Antimetabolites; D016685:Mitomycin; D005472:Fluorouracil