Long-term results of trabeculectomy with collagen sponge implant containing low-dose antimetabolite.

Abstract

Eighteen eyes of 15 patients with uncontrolled glaucoma (neovascular, intracapsular aphakia, uveitic, previous filtration failure) at high risk for failure of standard filtration underwent trabeculectomy with implantation of a purified collagen sponge containing 100 micrograms of antimetabolite (5-fluorouracil or bleomycin). Follow-up ranged from 3 months to 5 years. At the end of follow-up, 14 eyes (78%) had intraocular pressure below 21 mmHg and functional filtration blebs. No corneal toxicity was encountered at any time. Two patients (both successes) had partial or complete erosion of the collagen sponge. Although the differences were not statistically significant, patients receiving bleomycin had better success rates (8 of 9 versus 6 of 9) and lower intraocular pressure levels (11.88 mmHg versus 14.63 mmHg) than those receiving 5-fluorouracil. The collagen sponge implant demonstrates the clear advantages of drug delivery devices for the administration of antimetabolites after filtration surgery.