Trabeculectomy, Phacoemulsification, and Posterior Chamber Lens Implantation With and Without 5-Fluorouracil

Long-term outcome of primary glaucoma triple procedure with adjunctive 5-fluorouracil

“…However, there were no significant beneficial effects of adjunctive 5-FU on the filtration outcome of PGTP after 1 year in our prospective randomized study or in two subsequent similar studies by other investigators who used average total dosages of 25±43.7 mg of 5-FU [3,9,21]. On the other hand, we regarded it important to find out if adjunctive 5-FU might have a beneficial effect on the long-term filtration outcome of PGTP.…”

“…Subsequent studies by several investigators have shown, however, that low-dose 5-FU administration (total of 10±70 mg with average dosages of 28±40 mg) is as effective as full-course 5-FU treatment in filtration surgery with fewer short-term complications such as corneal epithelial toxicity and conjunctival wound leaks [6,10,19]. For this reason, and in consideration of the potential longterm side effects of ocular exposure to high-dose 5-FU, we selected low-dose 5-FU (total dosage of 25 mg from five daily injections) for our prospective randomized study on the effect of adjunctive 5-FU on the filtration outcome of PGTP in POAG patients [9]. The average total dosage of 5-FU actually administered in our study was 24.8 5.3 mg from 5.0 1.3 daily injections because four eyes received three injections of 15 mg due to severe complications of corneal epithelial toxicity and conjunctival wound leaks.…”

“…All patients received primary trabeculectomy combined with phacoemulsification and posterior chamber IOL implantation by the same surgeon (D.H.S.). The surgical procedure and the dosage of subconjunctival 5-FU were described in detail in the previous interim report [9]. Briefly, after PGTP, the patients in the 5-FU group received their first subconjunctival 5-FU injection (5 mg/0.1 ml) at the end of the surgery, followed by once-daily injections on postoperative days 1±3 and an injection at week 1, with slight variation from the protocol in some patients if required by the clinical situation, such as corneal epithelial defects and wound leaks.…”

“…Our previous interim evaluation of a prospective randomized study [9] and subsequent study by Wong et al [21], however, did not show any significant beneficial effect of adjunctive subconjunctival 5-FU on the short-term filtration outcome of PGTP in unselected primary openangle glaucoma (POAG) patients. In the current study, we have extended our previous short-term investigation to investigate the effect of adjunctive subconjunctival 5-FU on the long-term filtration outcome of PGTP in POAG patients.…”

Combined Cataract and Glaucoma Surgery

“…Both drugs act by inhibiting of proliferation of fibroblasts and probably also affect cell migration and extracellular matrix production. With rare exception, use of 5-FU with the procedure fails to demonstrate an advantage over the procedure when this antimetabolite is not used (Grady et al, 1993;Wong et al, 1994;Hurvitz, 1993). The results with MMC, however, show a reduction in IOP despite appreciable variability in the way in which MMC is applied.…”