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Abstract #6261 Published in IGR 2-2
Low-dose 5-fluorouracil trabeculectomy as initial surgery in uncomplicated glaucoma: long-term follow-up
Rothman RF; Liebmann JM; Ritch ROphthalmology 2000; 107: 1184-1190
OBJECTIVE: To compare the effectiveness of trabeculectomy with adjunctive, low-dose, subconjunctival 5-fluorouracil (5-FU) to trabeculectomy alone in patients with uncomplicated glaucoma undergoing their first incisional surgical procedure. DESIGN: Retrospective, nonrandomized comparative trial. PARTICIPANTS: Consecutive series of 52 patients and 74 control subjects. INTERVENTION: Trabeculectomy was performed in all patients. Study patients received adjunctive, subconjunctival injections of 5-FU up to 14 days from the date of surgery. MAIN OUTCOME MEASURES: Intraocular pressure, number of postoperative antiglaucoma medications, interventions, and complications were evaluated. RESULTS: Mean followup for all patients was 58.1 ± 44.1 months (range, 1.1-159.9 months). Mean followup for successful eyes was 55.9 ± 47.1 months (range, 7.6-159.9 months). The cumulative five-year success (intraocular pressure (IOP) < or = 21 mmHg) was 77.8% in the 5-FU group and 62.2% in the control group (p = 0.02, Wilcoxon test. Complete success (IOP < or = 21 mmHg without medications) at five years was lower in both the 5-FU group (72.3%) and the control group (51.3%). Postoperative mean IOP at five years for all successful patients was lower in eyes receiving 5-FU (10.7 ± 3.6 mmHg versus 16.0 ± 6.1 mmHg (p = 0.02, t test)). For those patients considered to be complete successes, there was no difference in IOP between the two groups of patients at any evaluated time interval. Patients in the 5-FU group were using 0.7 ± 1.1 medications at final followup compared with 1.8 ± 1.4 medications in the control group (p = < 0.0001, t test). Bleb-related ocular infection occurred in 6.3% of patients and was more common in patients receiving 5-FU than controls (six of 52 versus two of 74, respectively; p = 0.05, Fischer's exact test). CONCLUSIONS: Adjunctive, low-dose 5-FU at the time of initial surgery in uncomplicated glaucoma improves long-term IOP control and reduces the need for postoperative, antiglaucoma therapy. Eyes receiving 5-FU are at greater risk of developing late bleb-related ocular infection.
Dr. R.F. Rothman, Department of Ophthalmology, The New York Eye and Ear Infirmary, New York, NY, USA
Classification:
12.8.10 Woundhealing antifibrosis (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
