The Singapore 5-Fluorouracil Trial

Wong, Melissa H.; Husain, Rahat; Ang, Bryan Chin Hou; Gazzard, Gus; Foster, Paul J.; Htoon, Hla Myint; Wong, Tina; Oen, Francis T.S.; Khaw, PT; Seah, S.K.W.; Aung, Tin

doi:10.1016/j.ophtha.2012.12.004

Cited by 27 publications

(12 citation statements)

References 36 publications

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“…However, the efficacy of any surgical technique or augmentation is likely to be ultimately still mediated by the post-operative IOP [6], which remains the target of intervention after trabeculectomy. Previous results from the Singapore 5-FU Trial showed that while indeed there was no difference in IOPs between both the 5-FU and placebo groups, there was a trend toward eyes in the 5-FU group using fewer pressure-lowering medications 8 years after trabeculectomy [11].…”

Section: Discussionmentioning

confidence: 80%

“…The AGIS observed a higher prevalence of diabetes in patients with higher IOPs [1] which was attributed to their possibly-reduced response to IOP-lowering treatments. Diabetes was also a risk factor for sustained VF deterioration [11]. Law SK et al [30] demonstrated that diabetic POAG patients had poorer long-term IOP control and surgical survival rates.…”

Section: Discussionmentioning

confidence: 99%

“…Thereafter, as clinical and visual field assessments were carried out at various intervals, only IOP measurements taken within 1 month of all 6-monthly time-points post-trabeculectomy were retrospectively collected for analysis. As with prior studies, standard deviations (SD) of IOP readings were used as a surrogate for IOP fluctuation [6][7][8][9][10][11][12]. The use of 6-monthly IOP measurements for analysis avoids the undesirable effect that numerous measurements taken within a short period of time would have had on the overall standard deviation [8].…”

Section: Methodsmentioning

confidence: 99%

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Visual field progression 8 years after trabeculectomy in Asian eyes: results from The Singapore 5-Fluorouracil Study

et al. 2020

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Background/AimsThis work aimed to study the effect of long-term intraocular pressure (IOP) fluctuation on visual field (VF) progression 8 years post-trabeculectomy in Asian eyes.MethodsThis was a retrospective analysis of 8-year post-trabeculectomy data from The Singapore 5-Fluorouracil (5-FU) Study. VFs were analysed using Progressor software (Medisoft, Leeds, UK). Outcome measures included mean slope for VF per year, number of progressing points and mean slope for progressing points per year. Multivariate regression analyses were performed adjusting for age, gender, ethnicity, glaucoma type, intraoperative 5-FU, diabetes mellitus, hypertension, best pre-trabeculectomy VF mean deviation, post-trabeculectomy mean IOP, IOP reduction and IOP fluctuation (SD of IOPs at 6-monthly timepoints).Results127 (52.3%) subjects completed 8-year follow-up with ≥5 reliable VFs and ≥8 6-monthly IOP measurements. Mean age was 61.8±9.6 years. Post-operatively, mean IOP was 14.2±2.8 mm Hg and mean IOP fluctuation was 2.53±1.20 mm Hg. Higher IOP fluctuation was associated with greater mean slope for field (B=−0.071; p=0.013), number of progressing points (B=0.963; p=0.014) and VF progression as defined by ≥1 progressing point (OR=1.585; p=0.029). There was also a trend towards eyes with higher IOP fluctuation having ≥3 adjacent progressing points in the same hemifield (OR=1.489; p=0.055). Greater mean IOP reduction post-trabeculectomy was associated only with a lower mean slope for progressing points per year (B=−0.026; p=0.028). There was no significant effect of intra-operative 5-FU compared with placebo for all outcome measures.ConclusionIn post-trabeculectomy Asian eyes with well-controlled IOP, higher long-term IOP fluctuation may be associated with greater VF progression.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Visual field progression 8 years after trabeculectomy in Asian eyes: results from The Singapore 5-Fluorouracil Study

et al. 2020

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“…There was also a trend towards lower IOP medication use in the 5-FU group, although this did not reach statistical significance (23% versus 34%, p=0.06). However at 8 years, there was no significant difference in the IOP between the 5-FU and placebo groups 30 .…”

Section: Complications Related To Anti-metabolitementioning

confidence: 80%

Time Heals All Wounds: Obstacles in Glaucoma Surgery from an Asian Perspective

Toh

Lee

Chew

et al. 2015

Proceedings of Singapore Healthcare

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Glaucoma is the leading cause of irreversible blindness worldwide and is a particular burden on the Asian population. Glaucoma surgeries such as trabeculectomy and glaucoma drainage implants are routinely performed to lower intraocular pressure (IOP) to prevent disease progression. However, scarring of the filtering bleb limits their long-term success and Asian eyes are more at risk. Although this is so, many existing studies have been done on Caucasian patients, but few have focused solely on Asian patients. Intraoperative anti-metabolites such as Mitomycin-C (MMC) and 5-Fluorouracil (5-FU) are the current mainstay of adjunctive treatments to reduce scarring, and in this review, we evaluate the evolution, benefits and side effects of these agents. Recently, newer methods of wound modulation including anti-vascular endothelial growth factor (VEGF) agents and collagen implants are also being investigated as part of a multi-pronged approach to tackle this problem. Some opportunities exist to limit scarring post-operatively, but it is an ongoing battle.

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“…Although glaucoma filtration surgery (GFS) remains the 'gold standard' , there are marked GFS-related problems that have yet to be resolved [12][13][14] . For example, the excessive amount of tissue scarring that occurs post-GFS has the tendency to induce the development of thick connective tissue around scleral flaps and filtration blebs, making it difficult to regulate and maintain a reduction of the patient's intraocular pressure (IOP) for a prolonged period post-surgery [15][16][17] , even by anti-proliferative agents such as 5-fluorouracil (5-FU) and mitomycin C (MMC) [18][19][20][21][22] , occasionally detrimental to corneal and conjunctival tissues [23][24][25][26][27][28][29][30][31][32] .…”

mentioning

confidence: 99%

Pluripotent epigenetic regulator OBP-801 maintains filtering blebs in glaucoma filtration surgery model

Yamamoto¹,

Mukai²,

Ikushima³

et al. 2020

Sci Rep

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Inhibition of fibrosis is indispensable for maintaining filtering blebs after glaucoma filtration surgery (GFS). The purpose of this study was to investigate the ability of a pluripotent epigenetic regulator OBP-801 (OBP) to ameliorate extracellular matrix formation in a rabbit model of GFS. Rabbits that underwent GFS were treated with OBP. The gene expression profiles and intraocular pressure (IOP) were monitored until 30 postoperative days. The bleb tissues were evaluated for tissue fibrosis at 30 postoperative days. In in vitro models, OBP interfered the functions of diverse genes during the wound-healing process. In in vivo GFS models, the expressions of TGF-β3, MMP-2, TIMP-2 and 3, LOX, COL1A and SERPINH1 were significantly inhibited at 30 postoperative days in the OBP group compared with those in the vehicle control group. OBP treatment involving subconjunctival injection or eye drops showed no adverse effects, and reduced levels of α-SMA and collagen deposition at the surgical wound site. OBP maintained the long-lived bleb without scar formation, and IOP was lower at 30 postoperative days compared with the vehicle control group. These findings suggest that OBP is an effective and useful candidate low-molecular-weight agent for improving wound healing and surgical outcomes in a rabbit model of GFS.

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The Singapore 5-Fluorouracil Trial

Cited by 27 publications

References 36 publications

Visual field progression 8 years after trabeculectomy in Asian eyes: results from The Singapore 5-Fluorouracil Study

Visual field progression 8 years after trabeculectomy in Asian eyes: results from The Singapore 5-Fluorouracil Study

Time Heals All Wounds: Obstacles in Glaucoma Surgery from an Asian Perspective

Pluripotent epigenetic regulator OBP-801 maintains filtering blebs in glaucoma filtration surgery model

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