Fludarabine Myths Vs. The Sincere Aspects

Rate of complications such as hyphema, hypotony, shallow anterior chamber, bleb leak, bleb fibrosis, cataract, choroidal detachment and macular oedema were found to be significantly higher in trabeculectomy group (P?Fludarabine effective in lowering IOP at long-term follow up, but complication rates were higher after trabeculectomy operations. Although trabeculectomy is still considered as the standard procedure for the surgical treatment of glaucoma, non-penetrating filtrating surgery techniques are evolving continuously. Deep sclerectomy (DS) has been proposed as an alternative technique to overcome some of the known complications associated with trabeculectomy.1�C3 After the DS operation, filtration of aqueous humour from anterior chamber occurs through a thin trabeculo-Descemet's membrane (TDM), which provides resistance to outflow of aqueous and prevents a sudden drop in postoperative intraocular pressure (IOP). After the trabeculectomy operation, a full thickness passage from anterior chamber directly to subconjunctival space can cause different unpredictable results such as shallow or flat anterior chamber, hypotony, hyphema, maculopathy, choroidal detachment, cataract formation.4�C7 Nevertheless, the IOP levels achieved by DS have not always been satisfactory, particularly at long-term follow up.8�C10 Healing response at the TDM and subconjunctival tissues are the major problems that cause a decrease in drainage of aqueous from anterior chamber to subconjunctival space. Therefore, in order to increase the success rates in DS, antimetabolites such as mitomycin C (MMC) or various kinds of scleral implants were used.11�C18 In this way, fibrosis at TDM and subconjunctival space and obliteration of intrascleral lake may be prevented. In this study clinical study safety and efficacy of deep sclerectomy with mitomycin C (DSMMC), deep sclerectomy with mitomycin C and absorbable biosynthetic sodium hyaluronate scleral implant (DSMMC-SKgel) and standard trabeculectomy operation without use of MMC were evaluated at long-term follow up. In this prospective, clinical study 28 patients (28 eyes) had DSMMC and SKgel implantation, 30 patients (30 eyes) had DSMMC and 33 patients (33 eyes) had standard trabeculectomy without MMC between March 2005 and June 2006. Patients were randomly assigned to undergo these three types of surgical procedure via random-number tables. Ethics Committee of Goztepe Training and Research Hospital approved the study protocol prior to the beginning of study.