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The effect of 5-fluorouracil (5-FU) subconjunctival injection on the bleb formation and intraocular pressure (IOP) following trabeculectomy was studied in 18 glaucoma patients (20 eyes) with poor surgical prognosis. The results were analyzed by means of life tables and compared with those of 24 glaucoma eyes that had undergone trabeculectomy without postoperative administration of 5-FU after a previous repeat trabeculectomy that had failed. The surgical techniques and postoperative care were virtually identical between the eyes treated with 5-FU and eyes that had undergone repeat trabeculectomy, except that the latter group did not receive 5-FU postoperatively. At the end of 18-month follow-up, the success probability was 68.2% in the 5-FU treated eyes, and it was already as low as 10% in the nontreated eyes at the end of the 14-month follow-up. The difference was statistically highly significant (P less than 0.001). Postoperative, subconjunctival injection of 5-FU appears to improve the prognosis following trabeculectomy in patients with a poor surgical prognosis.

BackgroundBenign esophageal tumors are relatively rare, and a neurofibroma in the esophagus is extremely rare. Dysphagia is the most common clinical manifestation in patients with esophageal neurofibroma, and no cases of giant esophageal neurofibroma with severe tracheal stenosis have been reported.Case presentationA 73-year-old woman presented with shortness of breath, and computed tomography scan exhibited a giant mediastinal tumor causing severe tracheal stenosis. An upper gastrointestinal endoscopy revealed a giant submucosal lesion without mucosal changes located 18–23 cm from the incisor teeth. 18F-fluorodeoxyglucose (FDG)-positron emission tomography image revealed an upper mediastinal homogeneous mass and left supraclavicular lymph node with increased FDG accumulation. We performed endoscopic ultrasound-guided fine-needle aspiration biopsy; however, a definitive diagnosis could not be determined. During further investigation, her shortness of breath suddenly worsened and she suffered from wheezing. Because of risk of smothering, we decided to perform quasi-urgent lifesaving surgery. Under the preparation of extracorporeal membrane oxygenation (ECMO) when tracheal intubation fails, bronchial blocker was inserted over the tracheal stenosis and the left-lung ventilation was performed via intubation alone. Under general anesthesia, the patient was placed in the left lateral position and we performed right thoracotomy. The tumor strongly adhered to the trachea; however, the trachea or recurrent laryngeal nerves were not damaged in the surgery. Following esophagectomy, we performed gastric conduit reconstruction through the posterior mediastinum, and hand-sewn anastomosis was performed in the left neck. Immunohistochemical staining was positive for S-100 but negative for c-KIT, CD34, α-SMA, and desmin; these morphological and immunohistochemical characteristics were consistent with the diagnosis of neurofibroma.ConclusionsIt is often difficult to diagnose esophageal neurofibroma preoperatively. The preparation of ECMO could be considered in patients with severe airway obstruction for safe tracheal intubation. This is the first case of life-threatening giant esophageal neurofibroma with severe tracheal stenosis.