USE OF ANTIFIBROSIS AGENTS AND GLAUCOMA DRAINAGE DEVICES IN THE AMERICAN-GLAUCOMA-SOCIETY AND JAPANESE-GLAUCOMA-SOCIETY

Purpose: To investigate practice patterns among glaucoma subspecialist s in the American Glaucoma Society (AGS) and the Japanese Glaucoma Soc iety (JGS), regarding use of antifibrosis agents and glaucoma drainage devices. Methods: An anonymous survey incorporating 10 clinical situa tions was mailed to all AGS and JGS members in December 1995. Results: Half of the AGS (105 of 210) and JGS (25 of 50) members returned surv eys. Most respondents (51-87%) preferred trabeculectomy with adjunctiv e mitomycin for all 10 clinical situations. Mitomycin concentrations v aried from 0.1 to 0.8 mg/ml (range of means for 10 situations 0.31-0.3 9 mg/ml) and intraoperative application times ranged from 5 s to 7 min (range of means for 10 situations 2.5-4.6 min). Preferences for eithe r no antifibrosis agent (up to 39%) or 5-fluorouracil (up to 29%) were highest in primary trabeculectomy. Thirty-seven percent to 64% of AGS members used glaucoma drainage devices, especially after complicated Fostsurgical glaucomas (after penetrating keratoplasty, scleral buckli ng, or pars plana vitrectomy) and in neovascular glaucoma, but few JGS members used them. Large differences between university- and private practice-based AGS members were found only in mitomycin use for primar y trabeculectomy (33% vs. 52%, respectively; p = 0.07) and for complic ated postsurgical glaucomas (46% vs, 70%, respectively; p = 0.03), Con clusions: Trabeculectomy with mitomycin was the preferred surgical pro cedure among AGS and JGS members in the clinical situations surveyed. Mitomycin concentration and time of application varied widely. Many re spondents used 5-fluorouracil or no antimetabolite in primary trabecul ectomy. Glaucoma drainage devices were widely used for complicated gla ucomas in the United States.