[5-fluorouracil injection treatment after fistulating glaucoma operations]

Area of Science:

• Ophthalmology
• Glaucoma Management
• Surgical Adjuncts

Context:

• Subconjunctival 5-Fluorouracil (5-FU) injections have been used since 1984 to improve outcomes after filtering surgery for glaucoma.
• High-risk glaucoma patients, particularly those with a history of unsuccessful surgery and scarring, are candidates for this adjunctive therapy.
• A retrospective study was conducted to evaluate the efficacy and safety of 5-FU in this patient population.

Purpose:

• To assess the effectiveness of subconjunctival 5-Fluorouracil injections in controlling intraocular pressure (IOP) in high-risk glaucoma patients post-filtering surgery.
• To identify and analyze the side effects associated with this treatment modality.
• To determine if the benefits of 5-FU justify its use in light of potential complications.

Summary:

• A retrospective analysis of 29 eyes with high-risk glaucoma treated with subconjunctival 5-FU post-filtering surgery showed 89.6% achieved controlled IOP (reduced by >20% and consistently <21 mm Hg).
• Common side effects included conjunctival fistulas (24%) and corneal epithelial breakdown (69%).
• Evidence suggests 5-FU toxicity may affect the ciliary epithelium, leading to complications like e-vacuo symptoms and scarred filtration blebs, even in eyes with controlled IOP.

Impact:

• Subconjunctival 5-FU is a valuable tool for managing high-risk glaucoma cases prone to scarring, improving IOP control.
• The treatment is associated with significant adverse events, including ocular surface toxicity and potential ciliary body damage.
• 5-FU should be reserved for specific high-risk scenarios and not used in primary glaucoma surgery due to its risk-benefit profile.