Anti Metabolites In Glaucoma Surgery

ANTIMETABOLITES IN GLAUCOMA SURGERY

DR MITA JOSHI DR SACHDEV EYE HOSPITAL SURAT

WOUND HEALING PREACTIVATED CELLS INCISION/TISSUE DAMAGE BLOOD CLOT/GROWTH FACTORS AQUEOUS CHANGES

STOP MED/STEROIDS LESS INVASIVE /HEMOSTASIS HEMOSTASIS/FIBR IN/TPA/ANTI TGF /SURAMIN STEROIDS/NSAIDS

PMN /MACRO/LYMPHOC YTES RESPONSE FIBROBLAST ACTIVATION WOUND CONTRACTION COLLAGEN FORMATION

NSAIDS/ANTIMETA BOLITES ANTIMETABOLITES /PREOPSTEROIDS MMP INHIBITORS ANTI CONT AGENT INTERFERON ALPHA/ MMP INHIBITORS

MITOMYCIN C ANTINEOPLACTIC ANTIBIOTIC STREPTOMYCES CAESPITOSUS INHIBITS FIBROBLAST SYNTHESIS DNA SYNTHESIS AFFECTED A:G CROSS LINKING:CELL DEATH TOXIC TO ENDOTHELIUM AND CILIARY EPITHELIUM OTHER USES PTERYGIUM SURGERY,DCR

5 FLUROURACIL PYRIMIDINE ANALOGUE BINDS THYMIDYLATE SYNTHETASE INHIBITS DNA SYNTHESIS S PHASE OF MITOSIS CONTRAINDICATIONS OTHER USES : VITREO RETINAL SURGERY

INDICATIONS IN AGS MORE FLOW REGIMEN NEOVASCULAR GLAUCOMA CHRONIC PERSISTANT UVEITIS PREVIOUS FAILED TRAB APHAKIC GLAUCOMA CHRONIC CONJ INFLAM PREVIOUS CAT SURGERY LONG TERM TOPICAL ANTIGLAUCOMA MED

INDICATIONS IN AGS NORMAL TENSION GLAUCOMA YOUNG PTS AFRO CARREBIAN DESCENT

APPLICATION TECHNIQUES INTRA OPERATIVE USE MMC : 0.2 – 0.02 MG/ML FOR 3-5 MIN 5FU : 50 MG/ML / 25 MG/ML SITE OF APPLICATION: EPISCLERAL; UNDER THE SCLERAL FLAP SPONGES USED : PVA;METHYLCELLULOSE

IRRIGATION OF SITE DRAINAGE AREA :BACKWARD DIRECTION CLOSURE OF FLAP ADJUSTIBLE/RELEASABLE SUT LATE SR SMALLER SCLEROSTOMY LARGER FLAP

POST OPERATIVE USE 5FU SUBCONJ INJ 50MG/ML BD 7 DAYS, THEN OD 7 DAYS REDUCED TO OD INJ 7 DAYS AWAY FROM BLEB SITE USE OF VISCOELASTIC LATER INJ AROUND BLEB/NEEDLING W 5FU

COMPLICATIONS LARGE CYSTIC BLEB HYPOTONY : EXCESSIVE FILTRATION /REDUCED PRODUCTION WOUND EDGE LEAKAGE INTRAOCULAR PENETRATION INFECTION SCLERITIS/THINNING/NECROSIS K EPI DAMAGE/DEFECTS LATE BLEB LEAKAGE SUPRACHOROIDAL HAEMORRHAGE,RD HIGHER INCIDENCE OF CATARACT 5FU TERATOGENICITY

OTHER MODALITIES CORTICOSTEROIDS ANTI TGF B