The role of antimetabolites in filtration surgery for neovascular glaucoma: Intermediate-term follow-up

Abstract

Purpose: To compare the intermediate-term efficacy of 5-fluorouracil (5-FU) and Mitomycin C (MMC) as adjunctive antimetabolites in neovascular glaucoma (NVG) filtration surgery. Methods: Forty consecutive eyes of 40 patients with NVG refractory to medical therapy were randomized to receive antimetabolite-augmented trabeculectomy. Eighteen eyes received postoperative 5-FU (5-FU group) and 22 eyes received intraoperative, low-dose (0.2 mg/ml) MMC for 2 mins (MMC group). The main outcome measure was intraocular pressure (IOP). Surgical success was defined as IOP < 21 mmHg with topical treatment (qualified success) or without topical treatment (complete success). Surgical failure was defined as IOP ≥ 21 mmHg, despite postoperative topical treatment, and by postoperative blindness. Results: The mean follow-up period was 35.8 ± 22.6 months in the 5-FU group and 18.6 ± 17.2 months in the MMC group. This difference was not significant. Mean IOP decreased from 40.4 ± 10.3 mmHg to 14.7 ± 3.4 mmHg (p < 0.0001) in the 5-FU group and from 42 ± 11.3 mmHg to 22.9 ± 13.3 mmHg (p=0.0006) in the MMC group; however, the difference between the 5-FU and MMC groups was not significant at any point. The success rate in the 5-FU group was 55.5% (44.4% complete, 11.1% qualified), compared with 54.5% (9.1% complete, 45.4% qualified) in the MMC group. This difference was not significant. Conclusions: The percentage of patients who achieved postoperative IOP < 21mmHg was similar in both groups, although a larger proportion of patients treated with MMC-augmented trabeculectomy required topical treatment in comparison with the 5-FU group. © 2007 The Authors Journal compliation © 2007 Acta Ophthalmol Scand.