Trabeculectomy with intraoperative 5-fluorouracil

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Pharmacological Adjuncts

Background:

• Trabeculectomy is a primary surgical treatment for advanced glaucoma.
• Managing intraocular pressure (IOP) post-trabeculectomy often requires adjunctive therapies.
• 5-fluorouracil (5-FU) is used to modulate healing and prevent scarring after glaucoma surgery.

Purpose of the Study:

• To evaluate the efficacy and safety of combining intraoperative topical 5-fluorouracil (5-FU) with postoperative subconjunctival 5-FU injections.
• To assess the outcome and complication rates of this combined 5-FU regimen in trabeculectomy.
• To determine the impact on intraocular pressure control and the need for further interventions.

Main Methods:

• A cohort of 41 patients with advanced, medically uncontrolled glaucoma underwent trabeculectomy.
• Intraoperative episcleral 5-FU application (50 mg/ml for 5 minutes) was performed.
• Postoperative subconjunctival 5-FU injections were administered at the surgeon's discretion.

Main Results:

• Six-, 12-, and 15-month success rates (IOP ≤ 21 mm Hg) were 100%, 97%, and 83%, respectively.
• Mean postoperative IOP was 12.1 ± 4.3 mm Hg.
• Corneal epithelial erosions occurred in 17% of eyes; 5 of 7 patients with subsequent procedures maintained IOP control.

Conclusions:

• Trabeculectomy combined with intraoperative 5-FU is an effective strategy for IOP control in advanced glaucoma.
• This approach may reduce the requirement for frequent postoperative 5-FU injections.
• The combined regimen appears to minimize the incidence of corneal epitheliopathy compared to other methods.