Abstract
A controlled study was carried out to evaluate the effect of postoperative subconjunctival 5-fluorouracil (5-FU) injections on the surgical outcomes of trabeculectomy in the Japanese (a total of 196 eyes in 157 patients). The eyes that had undergone trabeculectomy with postoperative 5-FU (5-FU group) included 36 eyes with primary open-angle glaucoma (POAG) and 17 with secondary glaucoma (SG) undergoing their first or second trabeculectomy. There were also 34 eyes with refractory glaucoma. The eyes that had had trabeculectomy without postoperative 5-FU (control group) included 46 POAG and 31 SG eyes undergoing their first or second trabeculectomy and 24 refractory glaucoma eyes. The surgical techniques and postoperative care were virtually identical between the two groups, except that the control group did not receive 5-FU. The results were analyzed by means of a life table method and a postoperative intraocular pressure (IOP) level equal to or less than 20 mmHg was adopted as the criterion for successful IOP control. In the 5-FU group, the success probability (%) at the 3-year follow-up was 93.9 ± 4.2 (SE) for POAG eyes, 93.8 ± 6.1 for SG eyes, and 86.7 ± 5.6 for refractory glaucoma eyes. In the control group, it was 55.0 ± 7.9, 37.2 ± 13.5, and 16.1 ± 7.4, respectively. The difference in success probability between the 5-FU and control groups was highly significant (P < 0.001 or 0.01). In the POAG and SG eyes, the mean postoperative IOP was significantly lower in the 5-FU group than in the control group. Except for the fact that the corneal epithelial defect and conjuntival wound leak were encountered significantly more frequently in the 5-FU group, there was no significant difference in the incidences of postoperative complications between the 5-FU and control groups. Postoperative subconjunctival 5-FU increased the success probability of the trabeculectomy operation.
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References
Addicks EM, Quigley HA, Green WR, Robin AL (1983) Histologic characteristics of filtering blebs in glaucomatous eyes. Arch Ophthalmol 101:795–798
Bellows AR, Johnstone MA (1983) Surgical management of chronic glaucoma in aphakia. Ophthalmology 90:807–813
Berson D, Zauberman H, Landau L, Blumenthal M (1969) Filtering operations in Africans. Am J Ophthalmol 67:395–398
Chandler PA (1960) Long-term results in glaucoma therapy. Am J Ophthalmol 49:221–246
Desjardins DC, Parrish RK II, Forberg R, Nevarez J, Heuer DK, Gressel MG (1986) Wound healing after filtering surgery in owl monkeys. Arch Ophthalmol 104:1835–1839
Epstein DL (1986) Glaucoma due to intraocular inflammation. In: Epstein DL (ed) Chandler and Grant's glaucoma. Lea and Febiger, Philadelphia, p 362
Grant WM, Burke JF (1982) Why do some people go blind from glaucoma? Ophthalmology 89:991–998
Heath TD, Lopez NG, Lewis GP, Stern WH (1987) Antiproliferative and anticontractile effects of liposome encapsulated fluoroorotate. Invest Ophthalmol Vis Sci 28:1365–1372
Herschler J (1981) The effect of total vitrectomy on filtration surgery in the aphakic eye. Ophthalmology 88:229–232
Heuer DK, Parrish RK II, Gressel MG, Hodapp E, Palmberg PF, Anderson DR (1984) 5-fluorouracil and glaucoma filtering surgery. II. A pilot study. Ophthalmology 91:384–394
Heuer DK, Parrish RK II, Gressel MG, Hodapp E, Desjardins DC, Skuta GL, Palmberg PF, Nevarez JA, Rockwood JA (1986) 5-Fluorouracil and glaucoma filtering surgery. III. Intermediate follow-up of a pilot study. Ophthalmology 93:1537–1546
Inaba Z (1982) Long-term results of trabeculectomy in the Japanese: an analysis by life-table method. Jpn J Ophthalmol 26:361–373
Jerndal T, Lundstroem M (1977) 330 Trabeculectomies-a follow-up study through 1/2–3 years. Acta Ophthalmol 55:52–62
Kaplan EL, Meier P (1958) Nonparametric estimation for incomplete observations. J Am Stat Assoc 53:457–481
Kitazawa Y, Taniguchi T, Nakano Y, Shirato S, Yamamoto T (1987) 5-Fluorouracil for trabeculectomty in glaucoma. Graefe's Arch Clin Exp Ophthalmol 225:403–405
Knapp A, Heuer DK, Stern GA, Driebe WT Jr (1987) Serious corneal complications of glaucoma filtering surgery with post-operative 5-fluorouracil. Am J Ophthalmol 103: 183–187
Kolker AE, Hetherington J Jr (1983) Becker-Shaffer's diagnosis and therapy of the glaucomas. Mosby, St. Louis, pp 453–454
Kunitomo N, Mori S (1963) Studies on the pterygium. Report IV. A treatment of the pterygium by mitomycin C instillation. Acta Soc Ophthalmol Jpn 67:601–607
Lee DA, Flores RA, Anderson PJ, Leong KW, Teekhasaenee C, Kater AW, Hertzmark E (1987) Glaucoma filtration surgery in rabbits using bioerodible polymers and 5-fluorouracil. Ophthalmology 94:1523–1530
Merritt JC (1980) Filtering procedures in American blacks. Ophthalmic Surg 11:91–94
Miller RD, Barber JC (1981) Trabeculectomy in black patients. Ophthalmic Surg 12:46–50
Mills KB (1981) Trabeculectomy: a retrospective long-term follow-up of 444 cases. Br J Ophthalmol 65:790–795
Nevarez JA, Parrish RK II, Heuer DK, Hajek AS, Houdek PV, Mallick KS (1987) The effect of beta irradiation on monkey Tenon's capsule fibroblast in tissue culture. Curr Eye Res 6:719–723
Peyman GA, Schulman J (1985) Proliferative vitreoretinopathy and chemotherapeutic agent. Surv Ophthalmol 29:434–442
Rockwood EJ, Parrish RK, Heuer DK, Skuta GL, Hodapp E, Palmberg PF, Gressel MG, Feuer W (1987) Glaucoma filtering surgery with 5-fluorouracil. Ophthalmology 94:1071–1078
Rootman J, Tisdall J, Gudauskas G, Ostry A (1979) Intraocular penetration of subconjunctivally administered14C-fluorouracil in rabbits. Arch Ophthalmol 97:2375–2378
Ruderman JM, Welch DB, Smith MF, Shoch DE (1987) A randomized study of 5-fluorouracil and filteration surgery. Am J Ophthalmol 104:218–224
Shields MB, Campbell DG, Simmons RJ (1978) The essential iris atrophies. Am J Ophthalmol 85:749–759
Shirato S, Kitazawa Y, Mishima S (1982) A critical analysis of the trabeculectomy results by a prospective follow-up design. Jpn J Ophthalmol 26:468–480
Skuta GL, Parrish RK II (1987) Wound healing in glaucoma filtering surgery. Surv Ophthalmol 32:149–170
Smith TJ, Maurin MB, Milosovich SM, Hussain A (1987) A membrane based sustained release ocular delivery system for 5-fluorouracil. Invest Ophthalmol Vis Sci 28 [Suppl]:271
Taniguchi T, Kitazawa Y (1987) Value of topical 5-fluorouracil as adjunct to trabeculectomy. Jpn J Clin Ophthalmol 41:575–578
Tarr KH, Constable IJ (1980) Late complications of pterygium treatment. Br J Ophthalmol 64:496–505
Teng CC, Chi HH, Katzin HM (1959) Histology and mechanism of filtering operations. Am J Ophthalmol 47:16–34
Tominaga S (1980) Practical statistics for evaluation of therapeutic effects: the life-table analysis. Kanishobo, Tokyo
Uitto J (1970) A method for studying collagen biosynthesis in human skin biopsies in vitro. Biochem Biophys Acta 201:438–445
Watson PG, Grierson I (1981) The place of trabeculectomy in the treatment of glaucoma. Ophthalmology 88:175–196
Weinreb RN (1987) Adjusting the dose of 5-fluorouracil after filteration surgery to minimize side effects. Ophthalmology 94:564–570
Welsh NH (1972) Trabeculectomy with fistula formation in the African. Br J Ophthalmol 56:32–36
Yamanouchi U, Mishima K (1967) Eye lesions due to mitomycin C instillation after pterygium operation. Folia Ophthalmol Jpn 18:854–861
Yamashita H, Eguchi S, Yamamoto T, Shirato S, Kitazawa Y (1985) Trabeculectomy: a prospective study of complications and results of long-term follow-up. Jpn J Ophthalmol 29:250–262
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Nakano, Y., Araie, M. & Shirato, S. Effect of postoperative subconjunctival 5-fluorourcil injections on the surgical outcome of trabeculectomy in the Japanese. Graefe's Arch Clin Exp Ophthalmol 227, 569–574 (1989). https://doi.org/10.1007/BF02169454
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DOI: https://doi.org/10.1007/BF02169454