Low-dose perioperative 5-fluorouracil in trabeculectomy

5-Fluorouracil (5-FU) has been used to improve the outcome of trabeculectomy in high-risk cases, employing a postoperative regimen of subconjunctival injections. In light of recent laboratory evidence of the use of perioperative exposure to 5-FU, the authors investigated the outcome of this approach in their patients.

Twenty-three eyes of 21 patients who underwent trabeculectomy with a perioperative application of low-dose (25 mg/ml) 5-FU, with a minimum follow-up of 1 year, were reviewed retrospectively.

At 1 year postoperatively, 15 (65%) of the eyes had an intraocular pressure (IOP) of less than 21 mm Hg without treatment and 3 (13%) of the eyes achieved the same IOP with the same number of or fewer medications compared with on admission. The outright successful patients had a significantly shorter disease duration than the remaining patients (P < .05), despite having used a similar number of treatments on admission, and also had a significantly lower mean number of indications for antimetabolite use (P < .02). Few complications attributable to 5-FU were noted.

This route of administration appears to be safe and effective in patients requiring trabeculectomy who are not at a high risk for failure.