Late complications after glaucoma filtering surgery with adjunctive 5-fluorouracil

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Pharmacological Adjuncts

Background:

• Glaucoma surgery aims to reduce intraocular pressure (IOP) and prevent vision loss.
• Adjunctive medications, such as fluorouracil, are sometimes used to enhance surgical outcomes.
• Postoperative scarring can be a significant factor affecting the success of glaucoma filtration surgery.

Purpose of the Study:

• To evaluate the efficacy and safety of adjunctive fluorouracil in glaucoma filtering surgery.
• To compare outcomes between high-risk patients (previous surgery or inflammatory glaucoma) and those undergoing initial surgery.
• To identify and characterize late-onset complications associated with fluorouracil use.

Main Methods:

• A retrospective study of 105 patients (105 eyes) who underwent glaucoma surgery with adjunctive fluorouracil.
• Patients were followed for 12 to 48 months.
• Eyes were categorized into a high-risk group (previous surgery/inflammatory glaucoma) and an initial surgery group.

Main Results:

• Successful IOP control (≤20 mm Hg) was achieved in 84% of the high-risk group and 96.4% of the initial surgery group.
• Lower IOP (≤12 mm Hg) without medication was achieved in 34% of the high-risk group and 63.6% of the initial surgery group.
• Late complications included endophthalmitis (3.8%), leaking blebs (1.9%), prolonged hypotony (2.9%), giant blebs (1.9%), and iridocyclitis (8.6%).

Conclusions:

• Adjunctive fluorouracil can be effective in achieving target intraocular pressure after glaucoma filtering surgery.
• The use of fluorouracil is associated with a notable incidence of late-onset complications, predominantly bleb-related.
• Careful patient selection and monitoring are essential when using fluorouracil as an adjunct in glaucoma surgery.