Clinical Study
Eye (2007) 21, 784–788; doi:10.1038/sj.eye.6702328; published online 7 April 2006
Evaluation of efficacy and safety of daunorubicin in glaucoma filtering surgery
This paper was presented as poster at the Royal College of Ophthalmologist annual meeting in Manchester 2004
D Varma1, R Sihota1 and H C Agarwal1
1Dr R.P. Centre for Ophthalmic Sciences, New Delhi, India
Correspondence: D Varma, Department of Ophthalmology, Sunderland Eye Infirmary, Queen Alexandra Road, Sunderland SR2 9HP, UK. Tel: +44 191 5656256 ext 46210; Fax: +44 191 5699275. E-mail: deepalivarma@hotmail.com
Received 15 August 2005; Accepted 29 January 2006; Published online 7 April 2006.
Abstract
Purpose
To evaluate the intraocular pressure (IOP)-lowering effect and ocular side effects of daunorubicin (DNR) in drug-modulated trabeculectomy.
Methods
A prospective pilot study was conducted in which 21 Asian patients of Indian origin with high risk factors for failure of trabeculectomy were recruited. An approval from research ethics committee and an informed consent from every patient included in the study were obtained. DNR, an antimetabolite with known antifibroblastic action was used intraoperatively. A limbus-based conjunctival flap followed by conventional trabeculectomy was performed in all eyes. During trabeculectomy, a cellulose sponge soaked in 0.2 mg/ml DNR was applied for 3 min at the proposed site of trabeculectomy before preparation of the partial thickness scleral flap. A regular follow-up was carried out for 1 year where parameters including visual acuity, IOP by applanation tonometry, and slit lamp examination were performed on each visit. An IOP of 21 mmHg or less was taken as criteria for success.
Results
Following DNR trabeculectomy, the IOP was lowered from baseline preoperative value of 36.19
5.9 to 16.052.52 mmHg at the end of 1 year. Success rate of 81% (17 out of 21 patients) was noted. None of the patients developed corneal epithelial toxicity, hypotony maculopathy, or choroidal detachment.
Conclusion
The authors feel that intraoperative daunorubicin is safe and effective in lowering IOP in high-risk surgical cases of glaucoma. However, a much larger cohort study over a considerable number of years will eventually demonstrate its safety.
Keywords:
daunorubicin, glaucoma, anti-fibroblastic, trabeculectomy, intraocular pressure, high-risk factors
