Trabeculectomy With Intraoperative 5-Fluorouracil vs Mitomycin C

• Published in: American journal of ophthalmology Vol. 123; no. 1; pp. 48 - 53
• Main Authors: SINGH, KULDEV, EGBERT, PETER R., BYRD, SALLY, BUDENZ, DONALD L., WILLIAMS, ANDREW S., DECKER, JOSEPH H., DADZIE, PATIENCE
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.01.1997; Elsevier; Elsevier Limited
• Subjects: Antimetabolites - adverse effects; Antimetabolites - therapeutic use; Biological and medical sciences; Female; Fluorouracil - adverse effects; Fluorouracil - therapeutic use; Glaucoma - physiopathology; Glaucoma - surgery; Humans; Intraocular Pressure - drug effects; Intraoperative Care; Male; Medical sciences; Middle Aged; Mitomycins - adverse effects; Mitomycins - therapeutic use; Prospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the eye and orbit; Trabeculectomy; Treatment Outcome; Visual Acuity - drug effects; West Africa; Africa; Human; Trabeculectomy; Mitomycin; Antimetabolic; Surgery; Treatment efficiency; Fluoropyrimidine derivatives; Adjuvant treatment; Negroid; Intraoperative; Fluorouracil
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/S0002-9394(14)70991-2

To compare the effectiveness of intraoperative 5-fluorouracil (5-FU) and mitomycin C used adjunctively with trabeculectomy in a black West African population. Eighty-five consecutive eyes of 85 black patients undergoing primary trabeculectomy for open-angle glaucoma were prospectively randomly assigned to receive either 5-FU (50 mg/ml for 5 minutes) or mitomycin C (0.5 mg/ml for 3 ½ minutes) intraoperatively by soaked sponge. Of the 81 eyes with at least a 3-month postoperative follow-up, 41 of 44 (93.2%) in the mitomycin C group and 27 of 37 (73.0%) in the 5-FU group had a final intraocular pressure of less than 21 mm Hg (P = .01). Twenty-eight of 44 eyes (63.6%) in the mitomycin C group and 18 of 37 (51.4%) in the 5-FU group had a final intraocular pressure of less than 15 mm Hg (P = .26). Mean postoperative intraocular pressure was 13.7 mm Hg in the mitomycin C group and 16.3 mm Hg in the 5-FU group (P = .05). There were no differences between the two groups in mean age, preoperative intraocular pressure, postoperative visual acuity, and complications. Mean follow-up was 10.0 ± 4.41 months (range, 4 to 19 months). The adjunctive use of mitomycin C with trabeculectomy is equally safe and more efficacious compared to 5-FU in this West African population. Use of mitomycin C in this study was not associated with a statistically significantly greater proportion of patients achieving low intraocular pressure (less than 15 mm Hg) compared to 5-FU.