Outcomes and complications of trabeculectomy enhanced with 5-fluorouracil in adults with glaucoma secondary to uveitis.
OBJECTIVE
To analyze the long-term clinical outcomes of 5-fluorouracil (5FU)-enhanced trabeculectomy in patients with glaucoma secondary to uveitis (UG), to compare outcomes with those achieved elsewhere by primary mitomycin C-enhanced trabeculectomy and primary glaucoma drainage implant (GDI) surgery and to consider the optimal surgical approach in this group of patients.


METHODS
A retrospective analysis of a single-surgeon series of 31 eyes of 25 patients with UG attending the Manchester Uveitis Clinic who had undergone 5FU-enhanced trabeculectomy between October 2002 and August 2010. Main outcome measures were an intraocular pressure (IOP)<21 mm Hg with medications (unqualified success) and with medications (qualified success). Secondary outcome measures were IOP≤66% of initial IOP. Other risk factors and postoperative complications were also examined.


RESULTS
The mean follow-up was 5.1 years. Qualified success for postoperative IOP control of <21 was achieved in 90.3% at 1 year and 76.5% at 5 years. IOP<66% of initial IOP was achieved in 93.5% at 1 year and 82.3% at 5 years. No patients developed long-term hypotony. Patients under 30 years of age at surgery were at a higher risk for bleb failure and 50% in this age group went on to require GDI surgery.


CONCLUSIONS
This study demonstrates good long-term survival rates of 5FU-enhanced trabeculectomy in patients with UG, comparable with results for primary open-angle glaucoma. The results also compare favorably with those of mitomycin C-enhanced trabeculectomy and GDIs in patients with UG, with a lower risk of complications. We conclude that for patients over 30 years, 5FU-enhanced trabeculectomy is appropriate first-line surgery, whereas GDI surgery should be used as the primary procedure for those under 30 years.
Manchester Royal Eye Hospital, Oxford Road, Manchester, UK.
Anand
A
Chawla
Karl
K
Mercieca
Cecilia
C
Fenerty
Nicholas P
NP
Jones
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000963:Antimetabolites / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use*; D005901:Glaucoma / Q000188:drug therapy / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D020327:Glaucoma Drainage Implants; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome; D014605:Uveitis / Q000150:complications / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D055815:Young Adult
D000963:Antimetabolites; D016685:Mitomycin; D005472:Fluorouracil