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JF Jordan, M Diestelhorst, S Grisanti; Glaucoma Filtration Surgery with Photodynamic Therapy to Modulate Postoperative Wound Healing - A Clinical Pilot Study . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3337.
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Purpose:The study was designed to investigate the safety and efficacy of photodynamic therapy (PDT) to control postoperative fibrosis following glaucoma surgery. Methods:BCECF-AM [2,7,-bis- (2-carboxyethyl) -5- (and-6) -carboxy-fluorescein, acetoxy-methyl-ester] is a cell-membrane permeable compound, rendered membrane-impermeable and fluorescent upon cleavage by intracellular esterases. Prior to trabeculectomy (TE), 42 consecutive eyes of 37 glaucoma patients received a subconjunctival injection of 80µg BCECF-AM in the region of the later filtering blep. This was followed by an intra-operative, focal illumination with blue light (450-490 nm) for 8 minutes to activate the photodynamic effect of intracellular carboxyfluorescein. Antifibrotic efficacy was established as IOP reduction from baseline and by slitlamp examination. Success was defined as an IOP reduction of ≷20% and IOP constantly < 21 mmHg without any glaucoma medication. Results:Eyes had mean 1.1 preoperative surgical interventions. Mean preoperative IOP was 31.7 ± 8.5 mmHg. After mean 373 days follow-up (range: 0.5 - 36 months) IOP decreased significantly (p<0.001; t-test) in 26 eyes to 15.6 ± 5.7 mmHg without medication. 6 eyes showed good IOP reduction under topical antiglaucomatous medication. 10 eyes failed due to scarring within 2 to 67 weeks. Clinical follow-up examinations revealed no toxic effect, no blebitis, no uveitis, no endophthalmitis. Conclusion:Combination of TE and photodynamic therapy is an alternative approach to control postoperative wound healing in human eyes after glaucoma surgery. In contrast to Mitomycin C, cellular photoablation by means of carboxyfluorescein acts only on cells having incorporated the dye and being exposed to light of appropriate wavelength. Our data of human eyes combining TE with PDT underline the safety and efficacy of this new method. A controlled multi-center study will be performed in 2002.
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