Long-term results and complications after trabeculectomy with a single per-operative application of 5-fluorouracil

Abstract

We retrospectively evaluated a consecutive series of 45 patients (45 eyes) who underwent trabeculectomy augmented with a single intra-operative 5 minute application of 5-fluorouracil (5-FU; 25 mg/ml). All patients were at an increased risk of subconjunctival fibrosis and surgical failure. The mean follow-up period was 24 months (range 12-42, SD 6.9). The mean pre-operative intraocular pressure (IOP) was 29.1 mmHg (SD 6.1) and the mean IOP at the last post-operative visit was 16.6 mmHg (SD 6.4) (p < 0.0001) with a mean IOP reduction of 42%. The number of medications reduced from a mean of 2.3 (SD 0.7) pre-operatively, to 0.8 (SD 0.7) post-operatively (p < 0.0001) and 22 eyes (49%) required no topical treatment for IOP control. An IOP of 21 mmHg or less with or without medications was achieved in 80% of cases. There was no significant difference in final IOP or success rate over time between low- and high-risk patients, although the low-risk patients did better in the first 12-18 months. Complications included hypotony maculopathy in 2 cases (4%), leaking bleb in 5 cases (11%) and giant bleb in 1 case (2%), giving a total of 8 cases (18%) with bleb-related sequelae. In the short to medium term, a single per-operative application of 5-FU is a useful adjunctive treatment during glaucoma filtering surgery for low- to moderate-risk cases, although a steady increase in the failure rate was associated with increasing length of follow-up.

Dose, timing and frequency of subconjunctival 5-fluorouracil injections after glaucoma filtering surgery

“…However, adjunct therapy with 5-FU may be associated with an increase of vision-threatening complications, such as bleb-related endophthalmitis or hypotony maculopathy [31,32]. Since there is no exact dosage recommendation to date, two treatment modalities are currently used in the clinical setting: single intraoperative application of 5-FU [3,24,33] and postoperative subconjunctival injections of 5-FU [1,2,8,16,20,21,26,27]. Large fluctuations in the frequency of injections and absolute doses of 5-FU can be observed in the literature.…”

A review of trabeculectomy in East Asian people—the influence of race

“…7 Modifications introduced since then such as the introduction of antimetabolites have improved success rates. [8][9][10][11][12][13][14][15] This has been of particular benefit to those patients who were identified as having a higher risk for failure such as those who had had previous surgery, secondary glaucomas, young people, and non-Caucasian populations. It was established early on in its history that trabeculectomy in black subjects failed earlier compared to white subjects, presumably due to a more vigorous fibrotic response in the subconjunctival space.…”

Post-operative complication of trabeculectomy in Ibadan, Nigeria: outcome of 1-year follow-up

“…[9][10][11] most of which are aimed at reducing the complications and improving the success in term of IOP lowering effect.…”