Hi, Bev.

Antimetabolites have been popularly used during glaucoma surgery for
the past 10 years or so.  Mitomycin is quite a bit more potent than
5FU.  It prevents scarring of the scleral flap during a
trabeculectomy.  If scarring of the flap or conjunctiva occurs, the
outflow of fluid is decreased and therefore, the effect of the surgery
is lost (the pressure goes back up).  On the other hand, there are
other complications with mito, like too low of a pressure from either
overfiltration (too much fluid leaving under the flap) or a thin bleb
that develops eventual leaks and poses the risk of intraocular
infections.  This doesn't happen too commonly.  I use antimetabolites
on EVERY trab.  While I tell the patient about what it does, I never
include it as part of a separate informed consent, and I never leave
it up to the patient to decide whether or not to use it...how should
you know?  That would be like a car mechanic asking me what type of
oil filter I think is best for my car.  Don't ask ME...YOU'RE the
mechanic.  I've never heard of a surgeon leaving this up to the
patient or having a separate informed consent about it.  A trab
without mito has a much higher risk of failure due to excessive
healing, especially in younger patients, black patients, in patients
with a lot of conjunctival blood vessels (in other words, those with
red eyes) or in patients with a history of uveitis or inflamation of
the eyes.  I'm not telling you what to do since I don't know your
situation.  All I can do is give you some facts here.  If I were going
to have a trab, I'd be checking "yes" under the mito box for me (but
that's because I'm only 40 and I want my trab to last for at least 40
more years, if possible).  Good luck,
Rick Cohn, MD
Glaucoma specialist
Winter Park, FL