Modification of trabeculectomy with single-dose intraoperative 5-Fluorouracil application

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Surgical Adjuncts

Background:

• Glaucoma management often requires surgical intervention to reduce intraocular pressure (IOP).
• Trabeculectomy is a common surgical procedure for glaucoma.
• Enhancing trabeculectomy outcomes with adjunctive agents is an area of ongoing research.

Purpose of the Study:

• To evaluate the efficacy and safety of using intraoperative 5-Fluorouracil (5 FU) with trabeculectomy.
• To assess the impact of 5 FU on intraocular pressure reduction and surgical success rates.
• To compare outcomes between low-risk and high-risk glaucoma patient groups.

Main Methods:

• A prospective case series included 76 eyes of 76 glaucoma patients undergoing trabeculectomy.
• Intraoperative 5-Fluorouracil (5 FU) (25 mg/ml) was applied via sponge.
• Patients were followed for at least 6 months, with outcomes including IOP reduction and complications recorded.

Main Results:

• Mean preoperative IOP of 28 mmHg decreased to a final postoperative mean of 16.8 mmHg.
• The average number of glaucoma medications decreased significantly from 1.8 to 0.4 (p<0.001).
• Cumulative success rates (IOP < 21 mmHg) were 93% at 6 months and 81% at 12 months. Low-risk patients showed better outcomes when success was defined as IOP ≤ 15 mmHg and a 30% IOP reduction (p=0.033).

Conclusions:

• Intraoperative 5-Fluorouracil (5 FU) is a safe and effective adjunct to trabeculectomy.
• The procedure significantly reduces intraocular pressure and medication dependence.
• Achieving low teens IOP was more frequent in low-risk patients compared to high-risk patients.