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가토의 녹내장 여과술시 5-FU의 결막하주사와 국소도포의 효과 비교
백혜정,정해륜 고려대학교 의과대학 1993 고려대 의대 잡지 Vol.30 No.3
In an attempt to clarify the pharmacokinetics of 5-fluorouracil(5-FU) in the eye, we studied on the concentration change of 5-FU after single subconjunctival application with cellulose sponges soaked in 5-FU solution to the exposed sclera. Also we compared the use of single intraoperative application of subconjunctival 5-FU to filtration site with postoperative subconjunctival injections of 5-FU as an adjunctive therapy in glaucoma filtering surgery in rabbits. Precut cellulose sponges soaked in 10mg/ml, 25mg/ml, and 50mg/ml of 5-FU were placed on the sclera and subconjunctival tissue for 5 minutes on 72 eyes of 36 rabbits. Concentrations of 5-FU were assayed at 6 time intervals from 0.5 hour to 24 hours in conjunctiva, sclera, cornea, and aqueous. They showed a rapid decrease with time, but the 5-FU concentrations in the conjunctiva at 24 hours, in the sclera m d cornea at 12 hours were still above the reported 50% inhibition levels for the cultured conjunctival fibroblast proliferation(ID_(50)) with 50mg/ml. For the comparison of effect of postoperative and intraoperative 5-FU administration, posterior sclerectomy was performed on 54 eyes of 27 rabbits. Twenty eyes received single intraoperative 5-FU application(Group Ⅰ, 50mg/ml for 5 minutes), another 20 eyes were treated with low-dose postoperative subconjunctival 5-FU injections(Group Ⅱ, an average of 5 injections, mean total dosage 25mg), and the remaining 14 eyes were control(Group Ⅲ). Postoperative intraocular pressures(IOP) in both 5-FU treated groups were significantly lower than in untreated group until postoperative 2 weeks(p<0.05), but there were no significant differences between intraoperative and postoperative 5-FU administration. The most frequent complication was corneal epithelial defect in both 5-FU treated groups, which was resolved spontaneously. Histologically, inhibition of fibroblast proliferation and collagen fiber maturation at filtering site and subconjunctival area were more prominent in 5-FU treated groups than in untreated group. The sclerectomy sites were totally obstructed by the granulation tissue at postoperative 9 days in untreated group. In both 5-FU treated groups, partial obstruction by the fibroblasts and collagen fibers were seen from postoperative 2 weeks, and totally obstructed at postoperative 4 weeks. And there were no significantly different histological findings between intraoperative and postoperative administration. The above results suggest that single intraoperative adjunctive use of 5-FU with 50mg/ml is simpler and easier than postoperative subconjunctival 5-FU injections, and shows similar effects of postoperative IOP and inhibition of fibroblast proliferation with low-dose subconjuntival injection regimen on glaucoma filtering surgery in the rabbits.