Mitomycin C and 5-fluorouracil antimetabolite therapy for pediatric glaucoma filtration surgery.
OBJECTIVE
To evaluate the efficacy and safety of augmented trabeculectomy with 5-fluorouracil (5-FU) and mitomycin C (MMC) compared to 5-FU only for the treatment of pediatric glaucoma.


METHODS
In a prospective randomized clinical trial, 8 children (12 eyes) with pediatric glaucoma, either congenital or secondary to: lens aspiration, Sturge-Weber syndrome, or steroids underwent augmented trabeculectomy. Six patients (8 eyes) underwent augmented trabeculectomy with 5-FU plus MMC and 2 patients (4 eyes) underwent augmented trabeculectomy with 5-FU only.


METHODS
Between-group comparison of postoperative parameters: change in intraocular pressure (IOP), dependence on antiglaucoma medication, number of 5-FU injections, cup-disc ratio, corneal diameter, drug-induced complications.


RESULTS
In the 5-FU/MMC group, 7/8 eyes showed good control of postoperative IOP (9-16 mm Hg), which was independent of antiglaucoma therapy; only 2 injections of 5-FU were needed. By contrast, in the 5-FU group, no control of the postoperative IOP (21-23 mm Hg) was achieved in 4/4 eyes, and these patients remained dependent on antiglaucoma medication; up to 6 injections of 5-FU were used. There was no deterioration in the cup-disc ratio or the corneal diameter in either group. Results were maintained on follow-up (23-27 months). No significant drug-induced complications were noted.


CONCLUSIONS
Augmented trabeculectomy with adjunctive 5-FU/MMC may be an option for the control of pediatric glaucoma in patients with a poor surgical prognosis.
Snir
M
M
Pediatric Ophthalmology Unit, Schneider Children's Medical Center of Israel, Petah Tiqva.
Lusky
M
M
Shalev
B
B
Gaton
D
D
Weinberger
D
D
D000477:Alkylating Agents / Q000008:administration & dosage*; D000963:Antimetabolites / Q000008:administration & dosage*; D002675:Child, Preschool; D004333:Drug Administration Routes; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage*; D005901:Glaucoma / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D016685:Mitomycin / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D012449:Safety; D014130:Trabeculectomy; D014792:Visual Acuity
D000477:Alkylating Agents; D000963:Antimetabolites; D016685:Mitomycin; D005472:Fluorouracil