Dose, timing and frequency of subconjunctival 5-fluorouracil injections after glaucoma filtering surgery.
BACKGROUND
Although adjunctive postoperative 5-fluorouracil (5-FU) injections are known to improve the success rate of glaucoma surgery, it is still unknown what dose, timing and frequency of application will give the best results with respect to the inhibition of postoperative scarring and intraocular pressure regulation. We therefore designed the following retrospective investigation.


METHODS
We studied 172 eyes from 172 patients who had undergone trabeculectomy with adjuvant 5-FU-therapy. Variations of dosage, timing and frequency were analysed retrospectively. Surgery was defined as a complete success when the patient reached an intraocular pressure under 21 mmHg and a reduction of 20% 12 months after the operation. A relative success was achieved with these criteria under additional local medication. Not reaching these postoperative criteria for a complete success was classified as failure.


RESULTS
On average, adjunctive 5-FU-treatment was started 4.6+/-5.85 days postoperatively. The injections contained between 2 mg and 5 mg FU, and the mean total dose was 26.6+/-13.2 mg (range 5-65 mg). Surgery on 94 patients (54.65%) was classified as "complete success", that on 25 patients (14.53%) was classified as "relative success" and that on 53 eyes (30.81%) was classified as "failure" 12 months (+/-3 months) postoperatively. The best results were obtained when the treatment started on or before the first postoperative day (68.0-71.4% complete success; P<0.05). In contrast, an increase in 5-FU dosage did not result in an increased success rate of trabeculectomy. None of the 172 patients suffered from vision-threatening complications such as endophthalmitis or hypotony maculopathy.


CONCLUSIONS
Early treatment with 5-FU significantly increases the success rates of filtering surgery.
Reinthal
Eva Kristina
EK
Dept I, University Eye Clinic, Schleichstrasse 12, 72076, Tübingen, Germany. eva.reinthal@med.uni-tuebingen.de
Denk
Paul Oliver
PO
Grüb
Matthias
M
Besch
Dorothea
D
Bartz-Schmidt
Karl Ulrich
KU
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003228:Conjunctiva / Q000187:drug effects*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage*; D005901:Glaucoma / Q000601:surgery*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007267:Injections; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors; D014130:Trabeculectomy; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D005472:Fluorouracil