Long-term comparison of primary trabeculectomy with 5-fluorouracil versus mitomycin C in West Africa

• Published in: Journal of glaucoma Vol. 17; no. 7; p. 578
• Main Authors: Kim, Hanna Y, Egbert, Peter R, Singh, Kuldev
• Format: Journal Article
• Language: English
• Published: United States 01.10.2008
• Subjects: African Continental Ancestry Group - ethnology; Aged; Antihypertensive Agents - therapeutic use; Antimetabolites - administration & dosage; Antimetabolites - therapeutic use; Combined Modality Therapy; Cross-Sectional Studies; Female; Fluorouracil - administration & dosage; Fluorouracil - therapeutic use; Follow-Up Studies; Ghana - epidemiology; Glaucoma, Open-Angle - drug therapy; Glaucoma, Open-Angle - ethnology; Glaucoma, Open-Angle - surgery; Humans; Intraocular Pressure; Male; Middle Aged; Mitomycin - administration & dosage; Mitomycin - therapeutic use; Retrospective Studies; Trabeculectomy - methods; Treatment Outcome; Ghana
• ISSN: 1536-481X
• DOI: 10.1097/IJG.0b013e31816b304a

To compare the long-term efficacy and safety of intraoperative 5-fluorouracil (5-FU) versus mitomycin-C (MMC) used adjunctively with primary trabeculectomy in a Black West African population. Retrospective comparative study supplemented with cross-sectional follow-up data. Review of 68 eyes of 68 Black West African subjects that underwent primary trabeculectomy with the use of intraoperative 5-FU or MMC between January 1, 1988 and January 1, 2002 and had at least 3 years postoperative follow-up. Postoperative outcome measures included intraocular pressure (IOP) control, number of glaucoma medications, visual acuity, and complications. Thirty-eight of sixty-eight eyes received 5-FU and 30 received MMC. Mean postoperative follow-up was 7.5 and 6.5 years in the 5-FU and MMC groups, respectively (P=0.17). A higher proportion of eyes in the MMC group achieved "qualified" (with or without medical therapy) success with varying IOP targets relative to the 5-FU group, but the differences were not statistically significant. "Complete" (without medical therapy) postoperative success was greater in the MMC group with a significantly higher proportion achieving an IOP <21 mm Hg (P=0.02). MMC use was also associated with a lower likelihood of receiving IOP-lowering medications postoperatively (P=0.01). Baseline demographic characteristics, preoperative and postoperative IOP, visual acuity, and complications did not differ significantly between the 2 groups. Intraoperative MMC use is associated with a lower likelihood of requiring postoperative medications and a greater likelihood of achieving IOP lowering without medications relative to the use of 5-FU in a Black West African population.