Trabeculectomy with Intraoperative Sponge 5-Fluorouracil

Mora, Justin; Nguyen, Ngoc Hung; Iwach, Andrew G.; Gaffney, Michelle M.; Hetherington, John; Hoskins, H. Dunbar; Wong, Pui-Mun; Tran, Henry; Dickens, Christopher J.

doi:10.1016/s0161-6420(96)30578-2

Cited by 44 publications

(35 citation statements)

References 24 publications

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“…Superficial punctate keratitis was seen in only one eye (1.3%), This is much lower than the reported incidence of corneal complications (36-64%) in studies using subconjunctival 5 FU (Heuer et al 1986;The Flourouracil Filtering Study Group 1989;Liebmann et al 1991;Thomas 1993) and similar to that reported in other intraoperative 5 FU studies (Lanigan et al 1994;Mora et al 1996) The development of an epithelial defect and subsequent corneal abscess in an eye 4 months after surgery was most likely due to the preexisting ocular surface disorder. The incidence of bleb leaks (5.3%) was lower than the reported incidence of 20-33% for subconjunctival 5 FU administration (The Flourouracil Filtering Study Group 1989;Liebmann et al 1991).…”

Section: Discussionsupporting

confidence: 73%

“…Surgeons now recognize the need to achieve pressures in the low teens in order to prevent further visual field loss in glaucomatous eyes (Sommer 1996). 5-Fluorouracil, both in the form of postoperative injections and as intraoperative sponge application, has been used in low-risk eyes in the hope of enhancing the success rates as well as achieving low intraocular pressures (Liebmann et al 1991;Mora et al 1996). Repeated postoperative subconjunctival injections of 5 FU is a serious limiting factor.…”

Section: Discussionmentioning

confidence: 99%

“…Repeated postoperative subconjunctival injections of 5 FU is a serious limiting factor. Mora et al (1996) have recommended a combination of intraoperative sponge application of 5 FU followed by subconjunctival injections depending on the appearance of the bleb and the intraocular pressure. However, in the same paper they have suggested there was no difference in the final outcome between eyes which received postoperative 5 FU supplementation and those that didn't, after undergoing a trabeculectomy with intraoperative 5 FU.…”

Section: Discussionmentioning

confidence: 99%

“…In animal studies, after single 5 FU (50 mg/ml) application, survival of the filtration bleb has been shown to be significantly prolonged and these blebs were thicker than MMCtreated blebs . A recent report indicates that intraoperative 5 FU application appears to be as effective as postoperative subconjunctival 5 FU in lowering the IOP, but with a lower rate of corneal complications (Mora et al 1996). Moreover, the 5-Flourouracil Study Group (1996) has recommended in its 5-year follow-up report that caution be exercised in using 5 FU in high doses in eyes with a good prognosis, because of the observed high incidence of late bleb leaks.…”

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confidence: 99%

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

Anand

Sahni²,

Ménage³

1998

Acta Ophthalmologica Scandinavica

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ABSTRACT.Purpose: To assess the outcome of trabeculectomy supplemented with intraoperative 5-Fluorouracil (5 FU) application in glaucoma patients. Methods: A prospective non-randomized case series of 76 eyes of 76 consecutive patients who underwent trabeculectomy with intraoperative sponge 5 FU (25 mg/ ml). Minimum follow-up was 6 months. There were 31 eyes in the low-risk group and 45 eyes in the high-risk group. The reduction in intraocular pressure (IOP) and any treatment complications were noted. Results: The mean preoperative IOP was 28∫7.72 mm Hg. The mean final postoperative IOP was 16.8∫6.1 mm Hg. The average number of glaucoma medications required dropped from 1.8∫0.8 preoperatively to 0.4∫0.8 after the operation (p∞0.001). Cumulative success rates (IOP less than 21 mm Hg) for all eyes were 93% and 81% at 6 and 12 months, respectively. There was no difference in outcome between the low-and high-risk groups if criteria for success were an IOP of less than 21 mm Hg or an IOP of less than 21 mm Hg and an IOP reduction of 30%. However, if success is defined as an IOP of 15 mm Hg or less and a 30% fall in IOP, then the low-risk group had significantly longer survival times than the highrisk group (pΩ0.033, log-rank test). Transient punctate keratitis and corneal epithelial defect were each observed in only 1 eye. Other serious complications include rapid progression of cataract in 2 eyes, endophthalmitis in 1 eye and hypotonic maculopathy after subsequent cataract extraction in 1 eye. Conclusion: Single dose intraoperative 5 FU appears to be a safe and useful adjunct to trabeculectomy. IOPs in the low teens were achieved in a greater proportion of low-risk eyes than high-risk eyes.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

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

Anand

Sahni²,

Ménage³

1998

Acta Ophthalmologica Scandinavica

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“…There is a little doubt that MMC carries greater risk than does postoperative 5-FU. Zalish [55][56][57][58] To our knowledge, there is no published report on the results of intraoperative use of sponge 5-FU in refractory glaucoma following congenital cataract surgery. We think that trabeculectomy with intraoperative sponge 5-FU with a short course of postoperative subconjunctival supplementation (if required) may be a safer alternative in this type of refractory glaucoma.…”

Section: Resultsmentioning

confidence: 99%

Trabeculectomy with or without mitomycin-C for paediatric glaucoma in aphakia and pseudophakia following congenital cataract surgery

Mandal

Bagga

Nutheti³

et al. 2003

Eye

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Comparison of 90-s versus 5-min intraoperative 5-fluorouracil in trabeculectomy

2009

Self Cite

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To compare the relative efficacy of trabeculectomy surgery with 90-s and 5-min intraoperative exposure time to 5-fluorouracil. This was a retrospective, non-randomized comparative study. 41 eyes of 33 consecutive patients in the study group were compared to 40 eyes of 30 consecutive patients in the historical control group. Both groups were exposed to 5-fluorouracil (50 mg/ml) during trabeculectomy surgery. The exposure time was 90 s for the study group and 5 min for the control group. Three criteria were used to define surgical success: IOP (intraocular pressure) less than 21 mmHg; IOP less than 21 mmHg with more than 30% reduction in pressure; and IOP less than 15 mmHg with more than 30% reduction. The number of antiglaucoma medications, visual acuity, complications, and interventions were recorded at regular intervals. Mean preoperative IOP was 21.6 +/- 4.8 in the 90-s group and 21.2 +/- 4.9 in the 5-min group. Mean follow-up was 28.2 +/- 5.1 months in the 90-s group and 48.0 +/- 4.9 months in the 5-min group. During the first 30 postoperative months, there were no statistically significant differences in IOP and requirement for antiglaucoma medications between the two groups. The 90-s group had shorter survival rates using the 1st success criteria, but no significant difference was detected when the more stringent 2nd and 3rd criteria were applied. Choroidal effusions were significantly less common in the 90-s group (P = 0.0076). The results of this small study suggest that a 90-s application of 5-fluorouracil may be as effective as a 5-min one in trabeculectomy.

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Trabeculectomy with Intraoperative Sponge 5-Fluorouracil

Cited by 44 publications

References 24 publications

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

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

Trabeculectomy with or without mitomycin-C for paediatric glaucoma in aphakia and pseudophakia following congenital cataract surgery

Comparison of 90-s versus 5-min intraoperative 5-fluorouracil in trabeculectomy

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