Antimetabolite therapy with 5-fluouracil (5-FU) or
mitomycin-C (MMC) has significantly improved the success rate of
glaucoma filtration surgery. However, in some eyes, when filtration is excessive, persistent hypotony may develop. In this study, we describe the experience of using autologous
fibrinogen concentrate (AFC) to treat patients with persistent hypotony after
glaucoma filtration surgery. Among seven MMC-augmented
trabeculectomy patients who developed persistent postoperative hypotony, the effects of AFC intrableb
injections were evaluated. Under a microscope, 0.2 ml AFC and bovine
thrombin were injected into the
blebs of the patients from both sides of the filtering
blebs. Postoperative best-corrected visual acuity, anterior chamber status, intraocular pressure (IOP) and fundus examination were followed and compared with those preoperative. On the second day, the mean IOP of seven eyes elevated from preoperative 3.4 +/- 2.1 mmHg to 12.6 +/- 4.2 mmHg, and the anterior chamber became deep without obvious inflammatory response. Within two weeks,
macular edema and visual acuity were noted to improve in six eyes (85.7%). In addition, after a mean follow-up of 25 months, the
trabeculectomy procedure remained successful in all eyes. AFC appears to be safe and effective in the treatment of
ocular hypotony after
glaucoma filtration surgery.