Long-term comparison of primary trabeculectomy with 5-fluorouracil versus mitomycin C in West Africa.
OBJECTIVE
To compare the long-term efficacy and safety of intraoperative 5-fluorouracil (5-FU) versus mitomycin-C (MMC) used adjunctively with primary trabeculectomy in a Black West African population.


METHODS
Retrospective comparative study supplemented with cross-sectional follow-up data.


METHODS
Review of 68 eyes of 68 Black West African subjects that underwent primary trabeculectomy with the use of intraoperative 5-FU or MMC between January 1, 1988 and January 1, 2002 and had at least 3 years postoperative follow-up. Postoperative outcome measures included intraocular pressure (IOP) control, number of glaucoma medications, visual acuity, and complications.


RESULTS
Thirty-eight of sixty-eight eyes received 5-FU and 30 received MMC. Mean postoperative follow-up was 7.5 and 6.5 years in the 5-FU and MMC groups, respectively (P=0.17). A higher proportion of eyes in the MMC group achieved "qualified" (with or without medical therapy) success with varying IOP targets relative to the 5-FU group, but the differences were not statistically significant. "Complete" (without medical therapy) postoperative success was greater in the MMC group with a significantly higher proportion achieving an IOP <21 mm Hg (P=0.02). MMC use was also associated with a lower likelihood of receiving IOP-lowering medications postoperatively (P=0.01). Baseline demographic characteristics, preoperative and postoperative IOP, visual acuity, and complications did not differ significantly between the 2 groups.


CONCLUSIONS
Intraoperative MMC use is associated with a lower likelihood of requiring postoperative medications and a greater likelihood of achieving IOP lowering without medications relative to the use of 5-FU in a Black West African population.
Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA 97303, USA. hannakim@stanford.edu
Hanna Y
HY
Kim
Peter R
PR
Egbert
Kuldev
K
Singh
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D000963:Antimetabolites / Q000008:administration & dosage / Q000627:therapeutic use*; D044383:Black People / Q000208:ethnology; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000627:therapeutic use*; D005500:Follow-Up Studies; D005869:Ghana / Q000453:epidemiology; D005902:Glaucoma, Open-Angle / Q000188:drug therapy* / Q000208:ethnology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D000963:Antimetabolites; D016685:Mitomycin; D005472:Fluorouracil