Cyclosporin as an adjunct to glaucoma filtration surgery.
OBJECTIVE
Current adjunctive therapies to glaucoma surgery have unreliable effects, are toxic, and have numerous late complications associated with their use. This study examined whether topical cyclosporin (CsA) prolongs bleb survival after glaucoma filtration surgery.


METHODS
Anesthetized white New Zealand rabbits underwent glaucoma filtration surgery with a drainage tube. Cyclosporin (2%), applied intraoperatively or as topical treatment following glaucoma filtration surgery, was compared with intraoperative mitomycin C (MMC) and an untreated control group.


RESULTS
The bleb remained elevated for 15.1 +/- 3.2 days in the untreated control group, 12.2 +/- 2.1 days after intraoperative cyclosporin, and 27.5 +/- 1.7 days after intraoperative mitomycin C (P < 0.001). When topical treatment with cyclosporin followed intraoperative mitomycin C, bleb survival significantly decreased to 19.2 +/- 4.6 days (P = 0.003). Intraocular pressure (IOP) remained significantly reduced in the mitomycin C-treated group longer than in either the control or cyclosporine-treated groups.


CONCLUSIONS
In comparison with mitomycin C, neither intraoperative nor postoperative treatment with cyclosporin was associated with a decrease in intraocular pressure or prolonged bleb survival. Contrary to the initial hypothesis, topical treatment with cyclosporin actually mitigated the beneficial effects of mitomycin C on bleb survival. Clinical implications of these findings for patients with functioning blebs deserve further study.
Lattanzio
Frank A
FA
Thomas R. Lee Center for Ocular Pharmacology, Eastern Virginia Medical School, Norfolk, Virginia 23501, USA. lattanfa@evms.edu
Crouch
Earl R
ER
Mitrev
Peter V
PV
Williams
Patricia B
PB
Allen
Robert C
RC
D000287:Administration, Topical; D000818:Animals; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003228:Conjunctiva / Q000502:physiology / Q000601:surgery; D016572:Cyclosporine / Q000627:therapeutic use*; D005260:Female; D018463:Filtering Surgery; D005402:Fistula; D005901:Glaucoma / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007429:Intraocular Pressure; D007430:Intraoperative Care / Q000379:methods; D016685:Mitomycin / Q000627:therapeutic use; D009883:Ophthalmic Solutions; D011817:Rabbits
D000903:Antibiotics, Antineoplastic; D007166:Immunosuppressive Agents; D009883:Ophthalmic Solutions; D016685:Mitomycin; D016572:Cyclosporine