Objective: To evaluate the safety, tolerability and clinical effect on IOP of a carboxyfluorescein-ester as an adjunctive antifibrotic therapy in human glaucomatous eyes in order to control postoperative wound healing after trabeculectomy.
Methods: In 10 human glaucomatous eyes BCECF-AM was applied 15 minutes prior to trabeculectomy via a subconjunctival injection followed by intraoperative illumination with diffuse blue light (450-490 nm; ~ 51,9x103 cd/m2) for 8 minutes. Antifibrotic efficacy was established by clinical response, postoperative IOP reduction, slitlamp examination and photography of filtering blebs. Success was defined as an IOP < 21 mmHg from baseline without any antiglaucomatous medication.
Results: The mean IOP on the day before surgery was 37.2±11.2 mmHg. The IOP was 16.6±3.8 mmHg in 8 eyes after a mean follow-up of 400.1±38.1 days (p=0.0014). Two eyes showed scarring at the site of the filtering bleb within one month. Clinical examination revealed no toxic damage of adjacent tissues, no blebitis, no uveitis, no endophthalmitis.
Conclusions: We here report on the first 10 consecutive human glaucomatous eyes treated with a single dose of 80µg BCECF-AM during trabeculectomy. In contrast to chemotherapeutic agents cellular photoablation acts only on cells having incorporated BCECF-AM and being exposed to light of an appropriate wavelength. Though safety and efficacy demand for a controlled randomized study our method seems to be an effective therapeutic approach to control postoperative fibrosis in human glaucomatous eyes with poor surgical prognosis. Multiple parameters may be altered in the future to improve the antifibrotic effect of PDT during glaucoma surgery.