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Editors Selection IGR 12-4

Surgery: 5FU or MMC in Ghana

Comment by Keith Barton on:

22222 Long-term comparison of primary trabeculectomy with 5-fluorouracil versus mitomycin C in West Africa, Kim HY; Egbert PR; Singh K, Journal of Glaucoma, 2008; 17: 578-583

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There are enormous economic barriers to the successful management of glaucoma in the developing world where drugs may be unobtainable or unaffordable. Trabeculecotmy with 5-Flurouracil (5FU) or Mitomycin C (MMC), may offer the best or only chance to prevent blindness. Ethnically, West Africans, have a lower chance of good IOP control after trabeculectomy than other groups, but have greater need for successful surgery. Kim et al. (1711) report a retrospective study of 68 residents of the environs of one eye hospital in Ghana, who underwent primary trabeculectomy by a number of surgeons, using 5FU (38 eyes) or MMC (30 eyes), largely dependent on whichever was available, between 1998 and 2002 and who were followed-up for at least 3 years (mean 7.5 years for 5FU and 6.5 for MMC). Mean IOP at last follow-up was 20.0 mmHg 5FU, 18.0 mmHg MMC (NS) on 1.1 versus 0.3 (p = 0.0001) glaucoma medications. Success, (IOP < 21 mmHg without medication), was significantly better (55.2% versus 24.3%, p = 0.02) for MMC trabeculectomies. This difference was also apparent, but not significant with other lower IOP end-points. Percentage success for IOP < 21mmHg with or without medication was 52.6% (5FU) and 73.3% (MMC). It is worth noting the difficulties in obtaining prospective data, and especially long-term prospective data in West Africa and despite the obvious potential biases and limitations in a retrospective study, these results do represent real life and these results are of use in the context of the limited data available. The greater difference in absolute than qualified success is perhaps of greater significance in the developing world where medications are hard to come by. However, the observed worsening of visual acuity by greater than two lines in 50% of cases in both groups, shows that we have some way to go in understanding how best to help glaucoma sufferers in the developing world.

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