Prevention of corneal complications after post-operative application of antimetabolites following nonpenetrating deep sclerectomy
Authors:   Volga District Medical Center under the Federal Medical and Biological Agency, Nizhny Novgorod, Russian Federation, Svetozarskii S.N. ,   Privolzhsky Research Medical University under the Ministry of Health of Russia, Nizhny Novgorod, Russian Federation, Andreev A.N. ,   Volga District Medical Center under the Federal Medical and Biological Agency, Nizhny Novgorod, Russian Federation, Shvaikin A.V. ,   Volga District Medical Center under the Federal Medical and Biological Agency, Nizhny Novgorod, Russian Federation, Scherbakova S.V. ,   Volga District Medical Center under the Federal Medical and Biological Agency, Nizhny Novgorod, Russian Federation, Smetankin I.G. ,   Volga District Medical Center under the Federal Medical and Biological Agency, Nizhny Novgorod, Russian Federation,   Privolzhsky Research Medical University under the Ministry of Health of Russia, Nizhny Novgorod, Russian Federation
Published: April 2024

Original article Prevention of corneal complications after post-operative application of antimetabolites following nonpenetrating deep sclerectomy S.N. Svetozarskii, A.N. Andreev, A.V. Shvaikin, S.V. Scherbakova, I.G. Smetankin Volga District Medical Center under the Federal Medical and Biological Agency, Nizhny Novgorod, Russian Federation Privolzhsky Research Medical University under the Ministr y of Health of Russia, Nizhny Novgorod, Russian Federation Purpose. To evaluate the clinical and functional effectiveness of the developed method for prevention of corneal complications of nonpenetrating deep sclerectomy (NPDS) with postoperative adjuvant use of 5-fluorouracil in comparison with the control group. Material and methods. Retrospective comparative study in 2 groups included patients with open angle glaucoma who were initially underwent NPDS and received at least 1 subconjunctival injection of 5-fluorouracil in the postoperative period. 1st group included 101 patients (101 eyes) who underwent subconjunctival injection of 5-fluorouracil after surgery using standard technique, 2nd group included 176 patients (176 eyes) who underwent subconjunctival injection of 5-fluorouracil with prophylaxis of corneal complications. Best corrected visual acuity (BCVA), intraocular pressure (IOP), frequency of corneal complications and number of visits to the doctor during the first 4 weeks after surgery were analyzed as criteria of efficacy and safety. Results. Comparison groups did not differ in demographic characteristics and preoperative BCVA and IOP parameters. Fluorescein stained corneal epithelium defects were statistically significantly more frequently observed in 1st group (38.6%) in comparison with 2nd group (7.4%) (p<0.001). Four weeks after NPDS, IOP decrease was 25.5% in 1st group and 31.5% in 2nd group (p=0.042). Mean BCVA loss was 1.9 lines in 1st group and 1.3 lines in 2nd group (p<0.001). The number of follow-up visits during the first month after surgery was 0.6 less in 2nd group than in 1st group (p=0.002). Conclusion. Prevention of corneal complications simply and effectively reduces the risk of corneal epithelial defects after subconjunctival injection of 5-fluorouracil as well as markedly improves the clinical and functional results of NPDS and reduces the need for outpatient visits. Key words: antimetabolites, open-angle glaucoma, corneal erosion, toxicity, prevention of complications