Outcomes and complications of trabeculectomy enhanced with 5-fluorouracil in adults with glaucoma secondary to uveitis.

Abstract

PURPOSE:

To analyze the long-term clinical outcomes of 5-fluorouracil (5FU)-enhanced trabeculectomy in patients with glaucoma secondary to uveitis (UG), to compare outcomes with those achieved elsewhere by primary mitomycin C-enhanced trabeculectomy and primary glaucoma drainage implant (GDI) surgery and to consider the optimal surgical approach in this group of patients.

METHODS:

A retrospective analysis of a single-surgeon series of 31 eyes of 25 patients with UG attending the Manchester Uveitis Clinic who had undergone 5FU-enhanced trabeculectomy between October 2002 and August 2010. Main outcome measures were an intraocular pressure (IOP)<21 mm Hg with medications (unqualified success) and with medications (qualified success). Secondary outcome measures were IOP≤66% of initial IOP. Other risk factors and postoperative complications were also examined.

RESULTS:

The mean follow-up was 5.1 years. Qualified success for postoperative IOP control of <21 was achieved in 90.3% at 1 year and 76.5% at 5 years. IOP<66% of initial IOP was achieved in 93.5% at 1 year and 82.3% at 5 years. No patients developed long-term hypotony. Patients under 30 years of age at surgery were at a higher risk for bleb failure and 50% in this age group went on to require GDI surgery.

CONCLUSIONS:

This study demonstrates good long-term survival rates of 5FU-enhanced trabeculectomy in patients with UG, comparable with results for primary open-angle glaucoma. The results also compare favorably with those of mitomycin C-enhanced trabeculectomy and GDIs in patients with UG, with a lower risk of complications. We conclude that for patients over 30 years, 5FU-enhanced trabeculectomy is appropriate first-line surgery, whereas GDI surgery should be used as the primary procedure for those under 30 years.

• Authors: Anand Chawla, Karl Mercieca, Cecilia Fenerty, Nicholas P Jones
• Journal: Journal of glaucoma (J Glaucoma) 2013 Oct-Nov Vol. 22 Issue 8 Pg. 663-6 ISSN: 1536-481X [Electronic] United States
• PMID: 22706335 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Antimetabolites
• Mitomycin
• Fluorouracil

Topics

• Adult
• Aged
• Aged, 80 and over
• Antimetabolites (therapeutic use)
• Combined Modality Therapy
• Female
• Fluorouracil (therapeutic use)
• Glaucoma (drug therapy, etiology, surgery, therapy)
• Glaucoma Drainage Implants
• Humans
• Intraocular Pressure
• Male
• Middle Aged
• Mitomycin (therapeutic use)
• Postoperative Complications
• Retrospective Studies
• Risk Factors
• Trabeculectomy (methods)
• Treatment Outcome
• Uveitis (complications, drug therapy, surgery, therapy)
• Young Adult