Intraoperative application of 5-fluorouracil during trabeculectomy
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Published on: August 6, 2019
P J Dietze1, R M Feldman, R L Gross
1Cullen Eye Institute, Baylor College of Medicine, TX 77030.
Abstract:
We report the preliminary results of the first 20 consecutive cases in which the antimetabolite 5-fluorouracil (5-FU) was applied directly beneath the conjunctival flap during trabeculectomy in high-risk patients. Seventeen were considered early successes, with 3-month postoperative intraocular pressures less than 21 mmHg, representing at least a 20% decrease from preoperative values. Successful blebs were pale, with conjunctival microcysts and without significant vascularization over the trabeculectomy site, similar to the appearance of blebs in eyes administered postoperative subconjunctival injections of 5-FU. There were no cases of corneal epithelial defects, and no eyes had lost more than one line of preoperative vision at the time of last follow up. Although the longer term efficacy of this method is unknown, these results suggest that it may represent a safe and effective alternative for administering 5-FU.
Insights
This study explored applying 5-fluorouracil (5-FU) during glaucoma surgery. Preliminary results show this method is a safe and effective way to lower intraocular pressure in high-risk patients.
Area of Science:
- Ophthalmology
- Surgical Innovation
- Glaucoma Management
Background:
- Trabeculectomy is a common glaucoma surgery.
- High-risk patients often require adjunctive medication to manage intraocular pressure post-surgery.
- 5-fluorouracil (5-FU) is an antimetabolite used to enhance surgical success.
Purpose of the Study:
- To evaluate the preliminary safety and efficacy of applying 5-fluorouracil directly beneath the conjunctival flap during trabeculectomy.
- To assess early postoperative outcomes in high-risk glaucoma patients.
Main Methods:
- A prospective study of 20 consecutive high-risk patients undergoing trabeculectomy.
- 5-fluorouracil was applied directly beneath the conjunctival flap intraoperatively.
- Intraocular pressure (IOP) and visual acuity were monitored for 3 months postoperatively.
- Bleb characteristics were assessed visually.
Main Results:
- 17 out of 20 (85%) patients achieved early success, defined as 3-month postoperative IOP < 21 mmHg with at least a 20% reduction from baseline.
- Successful blebs exhibited a pale appearance with microcysts and minimal vascularization.
- No corneal epithelial defects were observed.
- No eyes lost more than one line of preoperative vision.
Conclusions:
- Direct subconjunctival flap application of 5-FU during trabeculectomy appears to be a safe and effective method for early IOP control in high-risk patients.
- The observed bleb morphology is consistent with successful antifibrotic action.
- Longer-term efficacy requires further investigation.
