[Use of "low dose" 5-fluorouracil during trabeculectomy]

This retrospective study was undertaken to evaluate if a "low dose" intraoperative sponge 5-fluorouracil application may improve the quality of the postoperative IOP control without increasing the incidence of postoperative complications following a first trabeculectomy in low-risk and/or severe field defects glaucomatous patients comparatively with a control group.

Our study included a total of 41 trabeculectomies performed in 39 patients. An intraoperative sponge 5-FU application (10 mg/ml) was performed during a mean duration of one minute in 28 trabeculectomies. Mean follow-up was 10.1 +/- 5.6 months (range: 3 to 24 months) and was comparable in 5-FU and control group. Mean age of patients (62.9 +/- 11.4 years) was not significantly different in both groups as well as their preoperative mean visual acuity, the severity of their visual field defects, the importance, the nature of preoperative topical medications and the number of sutures in scleral flap during trabeculectomy. The thickness of Tenon capsule was only significantly different in the two groups (p < 0.05). Our success criteria were based on a "target" IOP reached in the last examination with or without adjunctive medical treatment.

Mean preoperative IOP was 32.2 +/- 8.4 mm Hg and was reduced in the last control to a mean value of 14.4 +/- 4.0 mm Hg without any significant difference between the 5-FU group and the control group (p > 0.05). The rate of failures was higher in the control group (15.3%) than in the 5-FU group (7.1%) in the last examination. Significantly more eyes (31%) in the control group required adjunctive postoperative medication than in the 5-FU group (3%) in the last follow-up. The incidence and severity of complications were not significantly different in both groups. Postoperative 5-FU injections were performed in a non significant different number of eyes in one group comparatively with the other. Morphologic characteristics of filtration blebs were comparable in the two groups.

A "low dose" intraoperative 5-FU sponge application during a first trabeculectomy in low-risk patients and/or in patients with severe field defects in whom a low-ten target IOP is mandatory, seems to improve the postoperative IOP control without increasing the incidence of postoperative complications.