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Langzeitergebnisse nach Trabekulektomie mit 5-Fluorouracil

Long-term results after trabeculectomy with 5-fluorouracil

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Zusammenfassung

Fragestellung

Die Trabekulektomie (TE) gilt als eine Operation der ersten Wahl in der Glaukomchirurgie. Der Einsatz von Antimetaboliten, insbesondere Mitomycin C, hat die Erfolgsrate gesteigert. Diese Studie soll die Ergebnisse nach TE mit 5-Fluorouracil (5-FU) vorstellen.

Methodik

Es wurden 71 konsekutive Trabekulektomien mit 5-FU bei dekompensiertem Glaukom und einer Nachbeobachtungszeit von 1 Jahr retrospektiv ausgewertet. Der absolute (ohne Therapie) und relative Erfolg (mit Therapie) wurde für die Druckniveaus ≤ 21 mmHg, ≤ 18 mmHg, ≤ 15 mmHg und ≤ 12 mmHg nach 6 und 12 Monaten berechnet. Daneben wurden postoperative 5-FU-Gaben, Needlingprozeduren und Komplikationen erfasst.

Ergebnisse

Bei der Auswertung wurden insgesamt n = 55 Patienten berücksichtigt. Der Augeninnendruck (IOD) war präoperativ 29,6 ± 7,3 mmHg (3 ± 1,4 Wirkstoffe, teils Diamox), nach 6 Monaten 13,2 ± 4,1 mmHg, nach 1 Jahr 13,7 ± 4,3 mmHg. Nach 6 Monaten zeigte sich ein absoluter Erfolg für die angegebenen Druckniveaus bei 92, 87, 79 bzw. 52 %. Ein relativer Erfolg zeigte sich bei 96, 90, 81 bzw. 54 %. Nach 12 Monaten zeigte sich ein absoluter Erfolg für die angegebenen Druckniveaus bei 87, 84, 51 bzw. 56 %. Ein relativer Erfolg zeigte sich bei 96, 93, 58 bzw. 58 %. Einsatz von 5-FU postoperativ: keine Intervention bei n = 30; subkonjunktivale 5-FU-Gaben bei n = 25; Needling mit 5-FU bei n = 6. Eine passagere Hypotonie mit flacher Vorderkammer zeigte sich bei 6 Patienten, Kataraktentwicklung bei 5 Patienten. Ein Patient erlitt eine Hornhautdekompensation bei Zustand nach multiplen Voroperationen.

Schlussfolgerung

Die TE mit intraoperativer 5-FU-Gabe zeigt sehr gute Erfolgsraten nach 1 Jahr. Schwerwiegende Komplikationen werden selten beobachtet. Die intraoperative 5-FU-Gabe stellt eine mögliche Alternative zur TE mit Mitomycin C dar.

Abstract

Purpose

Trabeculectomy is among the first choice surgical treatments for glaucoma. Antimetabolites, especially mitomycin C, have improved the success rate. The aim of this study is to present the results of trabeculectomy with 5-fluorouracil (5-FU).

Methods

A total of 71 consecutive trabeculectomies with 5-FU for decompensated glaucoma with at least 1 year follow-up data were retrospectively evaluated. The absolute (without therapy) and relative (with therapy) success rates for glaucoma medication were determined for intraocular pressure (IOP) levels of ≤ 21 mmHg, ≤ 18 mmHg, ≤ 15 mmHg and ≤ 12 mmHg respectively. Postoperative 5-FU administration rates, needling procedures and complications were recorded.

Results

Sufficient follow-up data were available for a total of 55 patients. The average IOP was preoperatively 29.6 ± 7.3 mmHg (3 ± 1.4 active ingredients, partly acetazolamide), after 6 months 13.2 ± 4.1 mmHg and after 1 year 13.7 ± 4.3 mmHg. Complete success at 6 months postoperatively for the given pressure levels: were 92 %, 87 %, 79 % and 52 % and at 1 year 87 %, 84 %, 51 % and 56 %, respectively. Postoperative relative success for these pressure levels at 6 months were 96 %, 90 %, 81 % and 54 % and at 1 year 96 %, 93 %, 58 % and 58 %, respectively. Administrations of 5-FU postoperatively were no intervention (n = 30 patients), subconjunctival 5-FU administration (n = 25) and needling procedures (n = 6). A temporary hypotension with a shallow anterior chamber was seen in  6 patients, cataract development in 5 patients and 1 patient developed corneal decompensation (multiple previous operations before trabeculectomy).

Conclusion

Trabeculectomy with intraoperative 5-FU administration showed very high success rates after 1 year. Serious complications were rarely seen. Intraoperative 5-FU administration can be considered as an alternative treatment to trabeculectomy with intraoperative use of mitomycin C.

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Literatur

  1. Addicks EM, Quigley HA, Green WR, Robin AL (1983) Histologic characteristics of filtering blebs in glaucomatous eyes. Arch Ophthalmol 101:795–798

    Article  CAS  PubMed  Google Scholar 

  2. Anand N, Dawda VK (2012) A comparative study of mitomycin C and 5-Fluorouracil trabeculectomy in west Africa. Middle East Afr J Ophthalmol 19:147–152

    Article  PubMed Central  PubMed  Google Scholar 

  3. Cairns JE (1968) Trabeculectomy. Preliminary report of a new method. Am J Ophthalmol 1968:673–679

    Google Scholar 

  4. Chen CW (1983) Enhanced intraocular pressure controlling effectiveness of trabeculectomy by local application of mitomycin-C. Trans Asia-Pacific Acad Ophthalmol 9:172–177

    Google Scholar 

  5. Chen PP, Yamamoto T, Sawada A (1997) Use of antifibrosis agents and glaucoma drainage devices in the American and Japanese Glaucoma Societies. J Glaucoma 6(3):192–196

    Article  CAS  PubMed  Google Scholar 

  6. Daniels JT, Occleston NL, Crowston JG et al (1998) Understanding and controlling the scarring response: the contribution of histology and microscopy. Microsc Res Tech 42:317–333

    Article  CAS  PubMed  Google Scholar 

  7. Dreyer EB, Chaturvedi N, Zurakowski D (1995) Effect of mitomycin C and fluorouracil-supplemented trabeculectomies on the anterior segment. Arch Ophthalmol 113:578–580

    Article  CAS  PubMed  Google Scholar 

  8. Ehrnrooth P, Lehto I, Puska P, Laatikainen L (2002) Long-term outcome of trabeculectomy in terms of intraocular pressure. Acta Ophthalmol Scand 80:267–271

    Article  PubMed  Google Scholar 

  9. o A (1996) Five-year follow-up of the Fluorouracil Filtering Surgery Study. The Fluorouracil Filtering Surgery Study Group. Am J Ophthalmol 121:349–366

    Article  Google Scholar 

  10. o A (1989) Fluorouracil Filtering Surgery Study one-year follow-up. The Fluorouracil Filtering Surgery Study Group. Am J Ophthalmol 108:625–635

    Google Scholar 

  11. Hau S, Barton K (2009) Corneal complications of glaucoma surgery. Curr Opin Ophthalmol 20:131–136 (Review)

    Article  PubMed  Google Scholar 

  12. Heuer DK, Parrish RK II, Gressel MG et al (1984) 5-Fluorouracil and glaucoma filtering surgery, II: a pilot study. Ophthalmology 91:384–394

    Article  CAS  PubMed  Google Scholar 

  13. Hitchings RA, Grierson I (1983) Clinico-pathological correlations in eyes with failed fistulising surgery. Trans Ophthalmol Soc UK 103:84–88

    PubMed  Google Scholar 

  14. Joshi AB, Parrish RK 2nd, Feuer WF (2005) 2002 survey of the American Glaucoma Society: practice preferences for glaucoma surgery and antifibrotic use. J Glaucoma 14(2):172–174

    Article  PubMed  Google Scholar 

  15. Khaw PT, Migdal CS (1996) Current techniques in wound healing modulation in glaucoma surgery. Curr Opin Ophthalmol 7:24–33

    Article  CAS  PubMed  Google Scholar 

  16. Khaw PT (2001) Advances of glaucoma surgery: evolution of antimetabolite adjunctive therapy. J Glaucoma 10:81–84

    Article  Google Scholar 

  17. Kim HY, Egbert PR, Singh K (2008) Long-term comparison of primary trabeculectomy with 5-fluorouracil versus mitomycin C in West Africa. J Glaucoma 17:578–583

    Article  PubMed  Google Scholar 

  18. Lachkar Y, Leyland M, Bloom P, Migdal C (1997) Trabeculectomy with intraoperative sponge 5-fluorouracil in Afro-Caribbeans. Br J Ophthalmol 81:555–558

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Lama PJ, Fechtner RD (2003) Antifibrotics and wound healing in glaucoma surgery. Surv Ophthalmol 48:314–346

    Article  PubMed  Google Scholar 

  20. Lin ZJ, Li Y, Cheng JW, Lu XH (2012) Intraoperative mitomycin C versus intraoperative 5-fluorouracil for trabeculectomy: a systematic review and meta-analysis. J Ocul Pharmacol Ther 28:166–173

    Article  CAS  PubMed  Google Scholar 

  21. Marquardt D, Lieb WE, Grehn F (2004) Intensified postoperative care versus conventional follow-up: a retrospective long-term analysis of 177 trabeculectomies. Graefes Arch Clin Exp Ophthalmol 242:106–113

    Article  PubMed  Google Scholar 

  22. Mostafaei A (2011) Augmenting trabeculectomy in glaucoma with subconjunctival mitomycin C versus subconjunctival 5-fluorouracil: a randomized clinical trial. Clin Ophthalmol 5:491–494

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Oh SY, Youn DH, Kim DM, Hong C (1994) The effects of intraoperative mitomycin-C or 5-fluorouracil on glaucoma filtering surgery. Korean J Ophthalmol 8:6–13

    CAS  PubMed  Google Scholar 

  24. Palanca-Capistrano AM, Hall J, Cantor LB et al (2009) Long-term outcomes of intraoperative 5-fluorouracil versus intraoperative mitomycin C in primary trabeculectomy surgery. Ophthalmology 116:185–190

    Article  PubMed  Google Scholar 

  25. Reibaldi A, Uva MG, Longo A (2008) Nine-year follow-up of trabeculectomy with or without low-dosage mitomycin-c in primary openangle glaucoma. Br J Ophthalmol 92:1666–1670

    Article  CAS  PubMed  Google Scholar 

  26. Sidoti PA, Choi JC, Morinelli EN et al (1998) Trabeculectomy with intraoperative 5-fluorouracil. Ophthalmic Surg Lasers 29:552–561

    CAS  PubMed  Google Scholar 

  27. Singh K, Egbert PR, Byrd S et al (1997) Trabeculectomy with intraoperative 5-fluorouracil vs mitomycin C. Am J Ophthalmol 123:48–53

    Article  CAS  PubMed  Google Scholar 

  28. Singh K, Mehta K, Shaikh NM et al (2000) Trabeculectomy with intraoperative mitomycin C versus 5-fluorouracil. Prospective randomized clinical trial. Ophthalmology 107:2305–2309

    Article  CAS  PubMed  Google Scholar 

  29. Singh RP, Goldberg I, Mohsin M (2001) The efficacy and safety of intraoperative and/or postoperative 5-fluorouracil in trabeculectomy and phacotrabeculectomy. Clin Experiment Ophthalmol 29:296–302

    Article  CAS  PubMed  Google Scholar 

  30. Siriwardena D, Edmunds B, Wormald RPL, Khaw PT (2004) National survey of antimetabolite use in glaucoma surgery in the United Kingdom. Br J Ophthalmol 88:873–876

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  31. Smith MF, Doyle JW, Nguyen QH, Sherwood MB (1997) Results of intraoperative 5-fluorouracil or lower dose mitomycin-C administration on initial trabeculectomy surgery. J Glaucoma 6:104–110

    Article  CAS  PubMed  Google Scholar 

  32. Smith S, D’Amore PA, Dreyer EB (1994) Comparative toxicity of mitomycin C and 5-fluorouracil in vitro. Am J Ophthalmol 118:332–337

    CAS  PubMed  Google Scholar 

  33. o A (1993) Three-year follow-up of the Fluorouracil Filtering Surgery Study. Am J Ophthalmol 115:82–92

    Google Scholar 

  34. Vijaya L, Mukhesh BN, Shantha B et al (2000) Comparison of low-dose intraoperative mitomycin-C vs 5-fluorouracil in primary glaucoma surgery: a pilot study. Ophthalmic Surg Lasers 31:24–30

    CAS  PubMed  Google Scholar 

  35. WuDunn D, Cantor LB, Palanca-Capistrano AM et al (2002) A prospective randomized trial comparing intraoperative 5-fluorouracil vs mitomycin C in primary trabeculectomy. Am J Ophthalmol 134:521–528

    Article  CAS  PubMed  Google Scholar 

  36. Yoon PS, Singh K (2004) Update on antifibrotic use in glaucoma surgery, including use in trabeculectomy and glaucoma drainage implants and combined cataract and glaucoma surgery. Curr Opin Ophthalmol 15:141–146

    Article  PubMed  Google Scholar 

  37. Zahid S, Musch DC, Niziol LM et al (2013) Risk of endophthalmitis and other long-term complications of crabeculectomy in the Collaborative Initial Glaucoma Treatment Study (CIGTS). Am J Ophthalmol 155:674–680

    Article  PubMed Central  PubMed  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. A. Koutsonas, A. Remky und N. Plange geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Augenklinik, Universitätsklinikum Aachen, Pauwelsstr. 30, 52057, Aachen, Deutschland

    A. Koutsonas & N. Plange

  2. Krankenhaus Barmherzige Brüder, Regensburg, Deutschland

    A. Remky

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  1. A. Koutsonas
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Correspondence to A. Koutsonas.

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Koutsonas, A., Remky, A. & Plange, N. Langzeitergebnisse nach Trabekulektomie mit 5-Fluorouracil. Ophthalmologe 111, 749–756 (2014). https://doi.org/10.1007/s00347-013-2970-3

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