Skip to main content
The British Journal of Ophthalmology logoLink to The British Journal of Ophthalmology
. 2001 Sep;85(9):1028–1030. doi: 10.1136/bjo.85.9.1028

A randomised trial of the effect of intraoperative 5-FU on the outcome of trabeculectomy in east Africa

D Yorston 1, P Khaw 1
PMCID: PMC1724133  PMID: 11520747

Abstract

AIMS—To determine if intraoperative application of 5-fluorouracil (5-FU) improves the prognosis for trabeculectomy in east Africa.
METHODS—68 eyes with chronic open angle glaucoma were included in a randomised trial of intraoperative 5-FU versus placebo. Main outcome measures were intraocular pressures at 6 months and probability of failure at 2 years.
RESULTS—180 days after surgery the mean intraocular pressure (IOP) was 17.4 (SD 6.1) mm Hg in the placebo group and 16.9 (5.8) mm Hg in the 5-FU group. By 2 years after trabeculectomy, the probability of successful IOP control was 70.6% in the placebo group, and 88.8% in the 5-FU group. The placebo group was 2.18 times (95% CI 0.67 to 7.15) more likely to require additional IOP lowering procedures than the 5-FU group. Among patients followed for 2 years, 30% lost 0.3 logMAR units of visual acuity.
CONCLUSIONS—Trabeculectomy in Africa has an acceptable success rate which may be enhanced by the use of intraoperative 5-FU. It is estimated that this would cost approximately £1.25 per trabeculectomy failure prevented.



Full Text

The Full Text of this article is available as a PDF (144.5 KB).

Figure 1  .

Figure 1  

Kaplan-Meier survival curve for risk of trabeculectomy failure during first 2 years after surgery.

graphic file with name bjo-ppvm.f1.jpg

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bell R. W., Habib N. E., O'Brien C. Long-term results and complications after trabeculectomy with a single per-operative application of 5-fluorouracil. Eye (Lond) 1997;11(Pt 5):663–671. doi: 10.1038/eye.1997.174. [DOI] [PubMed] [Google Scholar]
  2. Buhrmann R. R., Quigley H. A., Barron Y., West S. K., Oliva M. S., Mmbaga B. B. Prevalence of glaucoma in a rural East African population. Invest Ophthalmol Vis Sci. 2000 Jan;41(1):40–48. [PubMed] [Google Scholar]
  3. Cook N. J. Evaluation of high volume extracapsular cataract extraction with posterior chamber lens implantation in Sierra Leone, west Africa. Br J Ophthalmol. 1996 Aug;80(8):698–701. doi: 10.1136/bjo.80.8.698. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Egbert P. R., Buchanan M. Results of extracapsular cataract surgery and intraocular lens implantation in Ghana. Arch Ophthalmol. 1991 Dec;109(12):1764–1768. doi: 10.1001/archopht.1991.01080120148046. [DOI] [PubMed] [Google Scholar]
  5. Egbert P. R., Williams A. S., Singh K., Dadzie P., Egbert T. B. A prospective trial of intraoperative fluorouracil during trabeculectomy in a black population. Am J Ophthalmol. 1993 Nov 15;116(5):612–616. doi: 10.1016/s0002-9394(14)73204-0. [DOI] [PubMed] [Google Scholar]
  6. Khaw P. T., Doyle J. W., Sherwood M. B., Smith M. F., McGorray S. Effects of intraoperative 5-fluorouracil or mitomycin C on glaucoma filtration surgery in the rabbit. Ophthalmology. 1993 Mar;100(3):367–372. doi: 10.1016/s0161-6420(93)31640-4. [DOI] [PubMed] [Google Scholar]
  7. Khaw P. T., Sherwood M. B., MacKay S. L., Rossi M. J., Schultz G. Five-minute treatments with fluorouracil, floxuridine, and mitomycin have long-term effects on human Tenon's capsule fibroblasts. Arch Ophthalmol. 1992 Aug;110(8):1150–1154. doi: 10.1001/archopht.1992.01080200130040. [DOI] [PubMed] [Google Scholar]
  8. Lanigan L., Stürmer J., Baez K. A., Hitchings R. A., Khaw P. T. Single intraoperative applications of 5-fluorouracil during filtration surgery: early results. Br J Ophthalmol. 1994 Jan;78(1):33–37. doi: 10.1136/bjo.78.1.33. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Occleston N. L., Alexander R. A., Mazure A., Larkin G., Khaw P. T. Effects of single exposures to antiproliferative agents on ocular fibroblast-mediated collagen contraction. Invest Ophthalmol Vis Sci. 1994 Sep;35(10):3681–3690. [PubMed] [Google Scholar]
  10. Quigley H. A., Buhrmann R. R., West S. K., Isseme I., Scudder M., Oliva M. S. Long term results of glaucoma surgery among participants in an east African population survey. Br J Ophthalmol. 2000 Aug;84(8):860–864. doi: 10.1136/bjo.84.8.860. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Singh K., Byrd S., Egbert P. R., Budenz D. Risk of hypotony after primary trabeculectomy with antifibrotic agents in a black west African population. J Glaucoma. 1998 Apr;7(2):82–85. [PubMed] [Google Scholar]
  12. Singh K., Egbert P. R., Byrd S., Budenz D. L., Williams A. S., Decker J. H., Dadzie P. Trabeculectomy with intraoperative 5-fluorouracil vs mitomycin C. Am J Ophthalmol. 1997 Jan;123(1):48–53. doi: 10.1016/s0002-9394(14)70991-2. [DOI] [PubMed] [Google Scholar]
  13. Verrey J. D., Foster A., Wormald R., Akuamoa C. Chronic glaucoma in northern Ghana--a retrospective study of 397 patients. Eye (Lond) 1990;4(Pt 1):115–120. doi: 10.1038/eye.1990.14. [DOI] [PubMed] [Google Scholar]
  14. Wormald R., Foster A. Clinical and pathological features of chronic glaucoma in north-east Ghana. Eye (Lond) 1990;4(Pt 1):107–114. doi: 10.1038/eye.1990.13. [DOI] [PubMed] [Google Scholar]
  15. al-Hazmi A., Zwaan J., Awad A., al-Mesfer S., Mullaney P. B., Wheeler D. T. Effectiveness and complications of mitomycin C use during pediatric glaucoma surgery. Ophthalmology. 1998 Oct;105(10):1915–1920. doi: 10.1016/S0161-6420(98)91041-7. [DOI] [PubMed] [Google Scholar]

Articles from The British Journal of Ophthalmology are provided here courtesy of BMJ Publishing Group

RESOURCES