Drainage devices are routinely placed in the eyes of patients with
glaucoma to reduce intraocular pressure (IOP) by providing controlled outflow of fluid (aqueous humor) via a filtering
bleb. However, the natural wound healing response often interferes with fluid outflow by thickening the walls of the
bleb over time, so that these devices rarely remain functional for more than 5 years. We investigated the use of controlled release of an
antimetabolite,
5-fluorouracil (5-FU), within
glaucoma drains to determine if the wound healing response could be reduced and the useful life span of the device increased.
Collagen plugs containing 1.125 mg of
5-FU were placed in the
silicone tubes of modified Baerveldt
glaucoma drains. Eight drains with
5-FU and eight drains without
5-FU were implanted in one eye each of 16 New Zealand white rabbits: the contralateral eyes served as unoperated controls. Results were evaluated in terms of IOP, fibrous
capsule thickness, macrophage density. and presence of
type III collagen surrounding the drain plate, 3 and 6 months after implantation. In general, eyes implanted with
antimetabolite-containing drains demonstrated significantly lower values for all evaluated parameters at 3 months and lower or equal values at 6 months, compared with the eyes not receiving
5-FU and the unoperated controls, indicating improved IOP-lowering function, reduced
bleb wall thickness, and earlier achievement of a steady-state wound healing response. All eyes remained healthy throughout the 6-month duration of the study with no cytotoxicity complications in any of the eyes. Thus, biodegradable plugs placed within the
silicone tubes of
glaucoma drains can safely deliver
5-FU to filtering
blebs over time, which could prolong the functional life of the
bleb by decreasing the thickness of the anterior fibrous
capsule and permitting sufficient fluid outflow to reduce IOP to physiological levels.