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Abstract #6263 Published in IGR 2-2
Post-operative 5-fluorouracil for glaucoma surgery
Wormald R; Wilkins MR; Bunce CCochrane Database of Systematic Reviews 2000; CD001132
BACKGROUND: Trabeculectomy is performed as a treatment for many types of glaucoma in an attempt to lower the intraocular pressure. The surgery involves creating a channel through the sclera, through which intraocular fluid can leave the eye. If scar tissue blocks the exit of the surgically created channel intraocular pressure rises and the operation fails. Antimetabolites are used to inhibit wound healing to prevent the conjunctiva scarring down on to the sclera. The principal antimetabolites used are 5-fluorouracil and mitomycin C. Both may be applied on a sponge between the conjunctiva and sclera at the beginning of surgery. 5-Fluorouracil may also be given as one or more injections under the conjunctiva after the surgery. OBJECTIVES: The objective of this review is to assess the effects of postoperative injections of 5-fluorouracil in eyes of people undergoing surgery for glaucoma. SEARCH STRATEGY: The authors searched the Cochrane Eyes and Vision Group specialized register, the Cochrane Controlled Trials Register (CENTRAL), MEDLINE and EMBASE. They searched the reference lists of relevant articles for additional trials, and used the Science Citation Index to search for articles that cited the included studies. They contacted investigators and experts for details of additional relevant trials. SELECTION CRITERIA: The authors included randomized trials of postoperative 5-fluorouracil injections compared to placebo injections or no injections in trabeculectomy for glaucoma. DATA COLLECTION AND ANALYSIS They independently assessed trial quality and extracted data. They contacted trial investigators for missing information. Data were summarized using relative risk, Peto odds ratio and weighted mean difference as appropriate. MAIN RESULTS: Eight trials, which randomized a total of 536 participants, are included in the review. As far as can be determined from the trial reports, the methodological quality of the trials was not high. 5-Fluorouracil, when delivered by postoperative injection, appears to be effective in reducing the likelihood of surgical failure of trabeculectomy both in eyes at high risk of failure and those undergoing surgery for the first time. Complications are more common after 5-fluorouracil injections, especially early and late wound leaks and temporary damage to the ocular surface. Whilst no evidence was found of an increased risk of serious sight threatening complications, people undergoing initial trabeculectomy had a substantially increased risk of ocular hypotony. None of the trials reported on the participants' perspective of care. REVIEWER'S CONCLUSIONS: This treatment is now rarely used on the basis of a planned series of postoperative injections.This presumably reflects an aspect of the treatment that is unacceptable to both patients and doctors. None of the trials reported on the participants' perspective of care which constitutes a serious omission for an invasive treatment such as this. Increasingly, injections are used on an ad hoc basis. The effectiveness of this strategy is the subject of a future systematic review.
Dr. R. Wormald, 'Glaxo' Department of Ophthalmic Epidemiology, Institute of Ophthalmology (UCL) and Moorfields Eye Hospital, City Road, London, UK, EC1V 2PD. r.wormald@ucl.ac.uk
Classification:
12.8.10 Woundhealing antifibrosis (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
