Use of 5-Fluorouracil injections to reduce the risk of trabeculectomy bleb failure after cataract surgery.
OBJECTIVE
To determine whether the use of postoperative subconjunctival 5-fluorouracil (5-FU) reduces the risk of trabeculectomy bleb failure after uncomplicated small incisional cataract surgery.


METHODS
Twenty-five consecutive patients with primary open-angle glaucoma and a functioning trabeculectomy bleb and who underwent uncomplicated phacoemulsification surgery were given subconjunctival injections of 5 mg 5-FU at 2, 4, and 12 weeks after cataract surgery (5-FU group). The mean postoperative intraocular pressure (IOP) over a 2-year period and the trabeculectomy survival rate, as determined by Kaplan-Meier survival analysis, was compared with a historical series of patients who had undergone cataract surgery in the presence of a filtering trabeculectomy bleb, but who had not received 5-FU (control group).


RESULTS
After a 2-year follow-up period, there was no significant difference in the mean IOP between the 5-FU (15.1 mm Hg SD 3.1) and control (15.3 mm Hg SD 3.3) groups (P = 0.67). An IOP > 21 mm Hg at any time point after the first postoperative month after cataract surgery was found in 4.0% cases in the 5-FU group and 16.7% cases in the control group (P = 0.78). Using Kaplan-Meier survival analysis, the difference in the cumulative probability of survival between the 5-FU and control groups was not significant (P = 0.30).


CONCLUSIONS
Cataract surgery is a significant risk factor for trabeculectomy bleb failure. The use of subconjunctival 5-FU injections at 2, 4, and 12 weeks after cataract surgery in elderly white patients with primary open-angle glaucoma does not reduce the risk of trabeculectomy failure.
Oxford Eye Hospital, West Wing, Oxford Radcliffe Hospitals NHS Trust, Oxford, United Kingdom. hummashahid@hotmail.com
Humma
H
Shahid
John F
JF
Salmon
D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000150:complications; D002387:Cataract Extraction / Q000009:adverse effects* / Q000379:methods*; D003228:Conjunctiva; D004334:Drug Administration Schedule; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage*; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000150:complications / Q000601:surgery*; D006801:Humans; D056965:Injections, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D014130:Trabeculectomy / Q000009:adverse effects*; D017211:Treatment Failure
D005472:Fluorouracil