Abstract
Trabeculectomy has a very high success rate,1-3 however, certain eyes are known to be at high risk of failure due to scarring of the conjunctival bleb. Such eyes include those with a previous failed filter, eyes with glaucoma secondary to uveitis and neovascularisation and the eyes of children and young adults. Trabeculectomy is generally accepted to have less successful results in patients of African race although good results are reported from some centres.4-8
The effectiveness of treatment with 5-fluorouracil in improving the results of trabeculectomy has been established in a number of pilot studies and clinical trials.9-16 Early studies used 100 mg of 5-fluorouracial in divided doses. Serious complications were recorded and lower dose regimes have been advised to improve the safety of the technique. Similar success in improving the chance of success to trabeculectomy has been found with doses of 40 mg with a lower incidence of side effects.14-16
We report complications associated with the use of 5-fluorouracil in a total dose of 50 mg in a group of 49 eyes undergoing trabeculectomy and postoperative 5-fluorouracil and describe the previously unreported increased incidence of thin cystic blebs in these eyes.
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Mills KB : Trabeculectomy: a retrospective long-term follow-up of 444 cases. Br J Ophthalmol 1981, 65: 790–5.
Migdal C and Hitchings RA : Results of primary trabeculectomy, a five year follow-up. Proceedings of the 14th International Congress of Ophthalmology, Singapore. 1990. (In press).
Watson PG and Grierson I : The place of trabeculectomy in the treatment of glaucoma. Ophthalmology 1981, 88: 175–96.
Beauchamp GR and Parks MM : Filtering surgery in children; barristers to success. Ophthalmology 1979, 86: 170–80.
Gressel MG, Heuer DK, Parrish RK : Trabeculectomy in young patients. Ophthalmology 1984, 91: 378–83.
Kolker AE and Hetherington J : Becker-Shaffer's Diagnosis and Therapy of the Glaucoma. St Louis, CV Mosby, 1983, pp 453–454.
Miller RD and Barber JC : Trabeculectomy in black patients. Ophthalmic Surg 1981, 12: 46–50.
Hoskins HD, Hetherington J, Shaffer RN : Surgical management of the inflammatory glaucomas. Perspect Ophthalmol 1977, 1: 173–81.
Heuer DK, Parrish RK, Gressel MG, Hodapp E, Desjardins DC, Skuta GL, Palmberg PF, Nevarez JA, Rockwood EJ : 5-fluorouracil and glaucoma filtering surgery. Intermediate follow-up of a pilot study. Ophthalmology 1986, 93: 1537–46.
Rockwood EJ, Parrish RK, Heuer DK, Skuta GL, Hodapp E, Palmberg PF, Gressel MG, Feuer W : Glaucoma filtering surgery with 5-fluorouracil. Ophthalmology 1987, 94: 1071–8.
Taniguchi T, Kitazawa Y, Shimizu U : Long-term results of 5-fluorouracil trabeculectomy for primary open-angle glaucoma. Inter Ophthalmol 1989, 13: 145–9.
The fluorouracil study group. Fluorouracil filtering surgery study one-year follow-up. Am J Ophthalmol 1989, 108: 625–35.
Ruderman JM, Welch DB, Smith MF, Shoch DE : A randomised study of 5-fluorouracil and filtration surgery. Am J Ophthalmol 1987, 104: 218–24.
Rabowsky JH and Ruderman JM : Low-dose 5-fluorouracil and glaucoma filtering surgery. Ophthalmic Surg 1989, 20: 347–9.
Krug JH and Melamed S : Adjunctive use of delayed and adjustable low-dose 5-fluorouracil in refractory glaucoma. Am J Ophthalmol 1990, 109: 412–18.
Weinreb RN : Adjusting the dose of 5-fluorouracil after filtration surgery to minimise side effects. Ophthalmology 1987, 94: 564–70.
Cairns JE : Trabeculectomy: Preliminary report of a new method. Am J Ophthalmol 1968, 5: 673–9.
Longstaff S, Wormald RPL, Masover A, Hitchings RA . Glaucoma Triple Procedure, results and efficacy of intraocular pressure control and visual outcome. Ophthalmic Surg (in press) 1990.
Knapp A, Heuer DK, Stern G, Driebe WT : Serious corneal complications of glaucoma filtering surgery with postoperative 5-fluorouracil. Am J Ophthalmol 1987, 103: 183–7.
Mannis MJ, Sweet EH, Lewis RA . The effect of fluorouracil on the corneal endothelium Arch Ophthalmol 1988, 106: 816–17.
Kornbleuth W and Tenenbaum E : The inhibitory effect of aqueous humour on the growth of cells in tissue cultures. Am J Ophthalmol 1956, 42: 70–4.
Teng CC, Chi HH, Katzin HM . Histology and mechanism of filtering operations. Am J Ophthamol 1959, 47: 16–34.
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Franks, W., Hitchings, R. Complications of 5—Fluorouracil after trabeculectomy. Eye 5, 385–389 (1991). https://doi.org/10.1038/eye.1991.63
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DOI: https://doi.org/10.1038/eye.1991.63
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