TOPICAL CYCLOSPORINE AS A POSSIBLE NEW ANTIMETABOLITE IN TRABECULECTOMY

BACKGROUND AND OBJECTIVE: The authors conducted a randomized, prospect ive, and controlled clinical and transmission electron microscopic stu dy to investigate the possible role of cyclosporine in trabeculectomy as an antimetabolite agent. PATIENTS AND METHODS: Twelve patients unde rwent trabeculectomy with topical cyclosporine and another 12 patients had trabeculectomy without cyclosporine. RESULTS: There was a statist ically significant decrease in the postoperative intraocular pressure (P < .05) and in the number of-medications needed postoperatively (P < .01) in the cyclosporine group. There were no significant complicatio ns in either group. Transmission electron microscopic examinations of the excised trabecular scleral tissue showed that cyclosporine caused inhibition of fibroblasts and led to a disruption in collagen organiza tion at the level of the surgical dissection. Middle scleral layers we re generally not affected except in some cyclosporine-treated eyes, wh ich showed only a mild cytopathic effect. CONCLUSION: This study showe d that topical cyclosporine was safe and effective for use as an antim etabolite in trabeculectomy. Further studies are needed to substantiat e the adjuvant role of cyclosporine in glaucoma filtering operations.