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Glaucoma surgery with or without adjunctive antiproliferatives in normal tension glaucoma: 1 Intraocular pressure control and complications
  1. W L Membrey,
  2. D P Poinoosawmy,
  3. C Bunce,
  4. R A Hitchings
  1. Glaucoma Unit, Moorfields Eye Hospital, City Road, London EC1V 2PD
  1. R A Hitchings Roger.Hitchings{at}virgin.net

Abstract

BACKGROUND Reduction of intraocular pressure (IOP) by 20–30% with glaucoma drainage surgery slows disease progression in normal tension glaucoma (NTG). It is not clear whether adjunctive antiproliferative agents are necessary or safe in eyes at low risk for scarring.

METHOD 86 eyes of 73 white NTG patients who had undergone a primary guarded fistulising procedure were reviewed. 25 eyes had no antiproliferatives, 36 had peroperative 5-fluorouracil (5-FU) and 25 had peroperative mitomycin C (MMC). Their postoperative IOPs, complications, and changes in visual acuity were recorded.

RESULTS Eyes that had no adjunctive antiproliferative less commonly maintained a 20–30% reduction in IOP (47.4% at 2 years) compared with either the 5-FU group (69.4%at 2 years, p=0.01) or the MMC group (64.9% at 2 years, p=0.04). Eyes that had adjunctive MMC more often had late hypotony (28%, p=0.02) and late bleb leak (12%, p<0.001). Eyes that had adjunctive MMC also more often had a two lines loss of Snellen visual acuity (39.8% by 2 years) compared with those that had adjunctive 5-FU (14.7% by 2 years), p=0.06.

CONCLUSION For NTG patients at low risk of scarring trabeculectomy with adjunctive peroperative 5-FU should maintain a suitable target IOP without the additional sight threatening complications seen with adjunctive MMC.

  • glaucoma
  • 5-fluorouracil
  • mitomycin C
  • intraocular pressure
  • trabeculectomy
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