title: Use of subconjunctival injections of 5-fluorouracil to rescue and prolong intraocular pressure reduction for a failing Ahmed glaucoma implant.
abstract: OBJECTIVE
  5-Fluorouracil (5-FU) has been well described for a failing trabeculectomy bleb, but not for aqueous shunts. We sought to determine whether subconjunctival 5-FU prolongs the intraocular pressure (IOP) efficacy of Ahmed shunts.
  
  
  METHODS
  We included all patients with Ahmed FP-7 implantation by one surgeon at Yale University. Patients with <3 months follow-up were excluded. Injections were done on a case-by-case basis, usually for IOP > 21 on >2 medications. Five-milligram (0.1 cc) injections were made over the plate. The control group consisted of Ahmed FP-7 patients without injections. The main outcome measure was IOP. Secondary outcome was success (IOP <21 mmHg, 20% decrease from preoperative IOP, and no reoperation).
  
  
  RESULTS
  The average age of controls was 72.5 ± 16.6 years, and 63.7 ± 18.8 with 5-FU (p = 0.02). Forty-four patients received 5-FU and 45 did not. Mean preoperative IOP in controls was 31.5 ± 11 mmHg on 3.1 ± 1 medications, and 31.9 ± 9.0 mmHg (p = 0.86) on 3.3 ± 0.9 medications with 5-FU (p = 0.18). At a mean 137 days after surgery, mean pre-injection IOP was 25.3 ± 7.7 mmHg on 2.0 ± 1.3 medications. Five years following implantation, control IOPs averaged 12.9 ± 7.1 mmHg (53% decrease from preoperative IOP, p < 0.001) on 1.4 ± 1.1 medications versus 17.2 ± 4.9 mmHg (46% decrease from preoperative, 32% decrease from pre-5FU IOP, p < 0.001) on 2.7 ± 0.8 medications with 5-FU. The IOP at 5 years was statistically similar in both groups (p = 0.23). Five-year success rates trended higher with 5-FU (77 vs. 67%, p = 0.38).
  
  
  CONCLUSIONS
  Subconjunctival injection of 5-FU sustained a significant long-term decline in intraocular pressures in eyes with failing Ahmed shunts. Outcomes between eyes receiving injections and controls were statistically similar.
authors.affiliation: Loma Linda VA, Loma Linda University, 11201 Benton St, Loma, Linda, CA, 92357, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Kaplowitz
authors.affiliation: Center for Advanced Eye Care, 3500 U.S. 1, Vero Beach, FL, 32968, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Khodadadeh
authors.affiliation: Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA.
authors.forename: Samantha
authors.initials: S
authors.lastname: Wang
authors.affiliation: Wills Eye Hospital, 840 Walnut Street Suite 1110, Philadelphia, PA, 19107, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lee
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York Eye and Ear Infirmary of Mount Sinai, 310 East 14th Street, New York, NY, 10003, USA. james.tsai@mssm.edu.
authors.forename: James C
authors.initials: JC
authors.lastname: Tsai
mesh_terms: D000368:Aged; D003228:Conjunctiva; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage*; D005500:Follow-Up Studies; D005901:Glaucoma / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D020327:Glaucoma Drainage Implants / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007267:Injections; D007429:Intraocular Pressure / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D011475:Prosthesis Failure; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D005472:Fluorouracil
keywords: 5-FU; Ahmed glaucoma implant; Glaucoma; Injection