Single intraoperative applications of 5-fluorouracil during filtration surgery: early results.

Abstract

between the sclera and the conjunctival flap, taking care not to expose the cut back edge of the conjunctival flap to the 5-FU soaked sponge. A typical sponge measured 6 mm (length) by 2 mm (width) by 1 mm (thickness). The sponge was removed, resoaked, and replaced every minute up to 5 minutes. The area was then rinsed with 20 ml of balanced salt solution over a period of 30-60 seconds through a Southampton irrigating cannula. Only after this was completed was a third to a half thickness rectangular scleral flap (4 mm by 3 mm) dissected and raised to the limbus. This was to minimise any intraocular penetration of 5-FU. A block of tissue measuring approximately 3 mm by 1 mm was resected and a peripheral iridectomy performed. The flap was then sutured down with four 10/0 nylon sutures. The back edge of the conjunctival incision was closed in a single layer with 10/0 nylon suture. All patients received postoperative topical dexamethasone metasulphobenzoate 0 1% eye drops four to six times a day and chloramphenicol eye drops four times a day.Eyes were examined on at least day 1, week 1, month 1, 3, 6, and 9 and intervals in between if clinically indicated. Postoperative observations and measurements included visual acuity, intraocular pressure (Goldmann applanation tonometry), slit-lamp biomicroscopy, and fundal examination. ResultsSurgery was performed on 34 eyes of 33 patients with intraocular pressure uncontrolled on maximally tolerated medical therapy. The causes of glaucoma in the eyes are listed in Table 1

Modification of trabeculectomy with single‐dose intraoperative 5‐Fluorouracil application

“…Superficial punctate keratitis was seen in only one eye (1.3%), This is much lower than the reported incidence of corneal complications (36-64%) in studies using subconjunctival 5 FU (Heuer et al 1986;The Flourouracil Filtering Study Group 1989;Liebmann et al 1991;Thomas 1993) and similar to that reported in other intraoperative 5 FU studies (Lanigan et al 1994;Mora et al 1996) The development of an epithelial defect and subsequent corneal abscess in an eye 4 months after surgery was most likely due to the preexisting ocular surface disorder. The incidence of bleb leaks (5.3%) was lower than the reported incidence of 20-33% for subconjunctival 5 FU administration (The Flourouracil Filtering Study Group 1989;Liebmann et al 1991).…”

“…Feldman et al (1994) reported 85.4% success rates (IOP less than 20 mm Hg, 20% drop from preoperative levels and a visual acuity loss ∞2 Snellen Chart lines) at six months after trabeculectomy with intraoperative 5 FU (50 mg/ml) in a varied group of glaucoma patients. Lanigan et al (1994) have reported success rates of 94% (IOP less than 22 mm Hg) in varied group of glaucoma patients. Egbert et al (1993) reported success rates (IOP less than 22 mm Hg) of 87% in black patients with glaucoma.…”

“…Also, the concentration of 5 FU used in the studies varies. Studies originating from the UK have used a 25 mg/ ml concentration of 5 FU (Smith et al 1992;Cunliffe et al 1993;Lanigan et al 1994), whereas those from the USA have used 50 mg/ml (Egbert et al 1993;Feldman et al 1994).…”

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.…”

Childhood glaucoma surgery in the 21st Century

“…29 The 1990s were also remarkable for the widespread introduction of anti-scarring agents in trabeculectomy surgery to improve success. 30,31 As a primary or secondary procedure in children, trabeculectomy was still associated with failure in many cases due to excessive scarring. In 1991, Miller and Rice 32 demonstrated that the use of beta radiation as an anti-scarring agent at the time of surgery prolonged trabeculectomy survival in children.…”