World view
A randomised trial of the effect of intraoperative 5-FU on the
outcome of trabeculectomy in east Africa
D Yorstona, P T Khawb
a Kikuyu Eye Unit,
Kikuyu, Kenya, b Wound Healing
Research Unit and Glaucoma Unit, Moorfields Eye Hospital and Institute
of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK
Correspondence to: Mr David Yorston, Department of Epidemiology and International Eye Health, Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK e.cartwright{at}ucl.ac.uk
Accepted for publication 20 April 2001
AIMS
To determine if
intraoperative application of 5-fluorouracil (5-FU) improves the
prognosis for trabeculectomy in east Africa.
METHODS68 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.
RESULTS180 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.
CONCLUSIONSTrabeculectomy
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.
© 2001 by British Journal of Ophthalmology
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