Three-Year Follow-Up of Trabeculectomy with 5-Fluorouracil

Abstract

Purpose: To evaluate the long-term outcome of trabeculectomy with intra- and postoperative 5-fluorouracil (5-FU) application in glaucoma. Methods: Eighty-six patients with glaucoma planned for primary trabeculectomy with 5-FU and a minimum follow-up of 3 years were retrospectively analyzed. Success rates, postsurgical 5-FU injections, needling procedures, and complications were analyzed. Results: Mean intraocular pressure (IOP) decreased from 27.2 ± 6.7 to 13.2 ± 4.2 mm Hg at 1 year and 13.8 ± 3.7 mm Hg at the 3-year follow-up. The complete success rates (no IOP-lowering medication) were 83, 79, 73, and 45% at 1 year for IOP ≤21, ≤18, ≤16, and ≤12 mm Hg, respectively, and 64, 59, 56, and 20% for these criteria at 3 years. The average number of medications decreased from preoperatively 2.9 ± 1.4 to 0.2 ± 0.5 at 1 year and 0.7 ± 1.1 at 3 years. During the first 6 months, subconjunctival 5-FU injections were performed in 49 cases. Eleven patients underwent bleb needling during the first 6 months and 13 patients underwent the procedure between the 6th month and the 3rd year. Malignant glaucoma and bleb-related endophthalmitis occurred in 1 patient each. Conclusions: Trabeculectomy with 5-FU is an efficient surgical procedure for glaucoma treatment when combined with intensified postsurgical care.

Cutting the subconjunctival fragment of the XEN gel implant during needling procedure

“…1 Despite the potential reduction of IOP following trabeculectomy with the use of antimetabolites, several visionthreatening complications may still occur, such as hypotony maculopathy, choroidal effusion, suprachoroidal hemorrhage, and bleb-related endophthalmitis. 1,2 The XEN gel implant, a hydrophilic, non-inflammatory, subconjunctival gelatin stent (XEN Gel Stent, Allergan, Dublin, USA), provides an ab interno approach to create a permanent channel from the anterior chamber to the subconjunctival space and is designed to avoid early postoperative hypotony. 3,4 The flexibility of the implant and its expansion upon hydration allow it to be tissue conforming and thus preventing the risk of extrusion and migration.…”

“…Trabeculectomy remains the gold standard of surgical glaucoma therapy. 1 Despite the potential reduction of IOP following trabeculectomy with the use of antimetabolites, several vision-threatening complications may still occur, such as hypotony maculopathy, choroidal effusion, suprachoroidal hemorrhage, and bleb-related endophthalmitis. 1,2…”

Two-year outcome of Trabeculo-Canalectomy for Chinese Glaucoma Patients

“…International and domestic studies reported that IOP drop rate of trabeculectomy combined with anti-metabolizing drugs or releasable sutures in PACG patients was 44-70% [13]. The success rate of trabeculectomy at 6 months postoperatively was 72%-91% [14] and 54-65% at 3 years postoperatively [15][16][17], which depends on follow-up time and the criteria used to define the successful outcome. In our study, no visible filtering blebs were observed in all eyes 3 months post-operatively (Figure 3), which fully demonstrated the efficacy of internal Schlemm's canal drainage.…”

Patterns of conjunctival and scleral regeneration after intraoperative application of cyclosporin A solution in rabbits with steroid-induced glaucoma

“…Для обеспечения стабильного и длительного гипотензивного эффекта после антиглаукомных операций нередко используются антиметаболические препараты (5-фторурацил, митомицин С), препятствующие пролиферации тканей в зоне вмешательства с рубцеванием искусственно созданных путей оттока внутриглазной жидкости [2][3][4][5][6]. Однако широкое применение антиметаболитов ограничено из-за риска развития в послеоперационном периоде таких осложнений, как вторичная макулопатия, кератопатия, прогрессирование катаракты, гипотония глаза [2].…”