Late onset of sequential multifocal bleb leaks after filtration surgery with antimetabolites (5-fluorouracil and mitomycin C)

Document Type

Journal Article

Publication Date



Investigative Ophthalmology and Visual Science






Purpose. Antimetabolites increase the success of filtration surgery but also increase the post-operative complications. We describe the late onset of sequential multifocal bleb leaks as a previously unreported postoperative complication after filtering surgery with antimetabolites. Methods. A retrospective chart review of trabeculectomies from 1989 to 1994 was performed. Clinical appearance of the filtering area, natural history and treatment mode from all patients as well as bleb histopathology from those eyes undergoing surgical revision are presented. Results. In seven out of 385 (1.8%) surgical filtering procedures, repetitive bleb leaks in different locations of the bleb were observed at times ranging from 9 to 44 months after the procedure. All eyes had transparent avascular cystic blebs. Five were from eyes treated with postoperative subconjunctival 5-fluorouracil (5-FU) and two of these were from eyes in which mitomycin C (MMC) was used intraoperatively. Mean onset of leaks was 20.4 months after surgery. Three cases (all 5-FU treated) required surgical revision and five healed with soft contact lens, histacrylic glue or intrableb injection of autologous blood. Focal epithelial thinning and interruption with subjacent hypocellularity and stromal collagen degeneration characterize the histologic appearance of the leak sites. Conclusions. Late sequential multifocal bleb leaks may occur after administration of antimetabolites (5-FU or MMC) and are associated with epithelial breakdown and stromal collagen necrosis.

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