Topical Cyclosporine as a Possible New Antimetabolite in Trabeculectomy

BACKGROUND AND OBJECTIVE: The authors conducted a randomized, prospective, and controlled clinical and transmission electron microscopic study to investigate the possible role of cyclosporine in trabeculectomy as an antimetabolite agent. PATIENTS AND METHODS: Twelve patients underwent trabeculectomy with topical cyclosporine and another 12 patients had trabeculectomy without cyclosporine. RESULTS: There was a statistically 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 complications 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 organization at the level of the surgical dissection. Middle scleral layers were generally not affected except in some cyclosporine-treated eyes, which showed only a mild cytopathic effect. CONCLUSION: This study showed that topical cyclosporine was safe and effective for use as an antimetabolite in trabeculectomy. Further studies are needed to substantiate the adjuvant role of cyclosporine in glaucoma filtering operations.