Trabeculectomy With Intraoperative 5-Fluorouracil In Enugu, South-Eastern Nigeria: A Pilot study

Abstract

AIM: To determine the outcome of 5 FU applied at time of trabeculectomy in Nigerian patients with open-angle glaucoma who had primarily received medical therapy. Patients were 13 adult Nigerian seen consecutively in the Glaucoma Clinic between September 1996 and November 1997. All had open-angle glaucoma and had primarily been treated with topical anti-glaucoma therapy. None required a combined surgical procedure and they were on their topical anti-glaucoma therapy except Pilocarpine until the day of surgery. Each patient was followed up for at least 3 months. The surgical technique was similar to Cairns: Just prior to raising the sclera for 5 minutes with or without apposition of the conjunctival flap over the swab. This was followed by copious irrigation with normal saline and then raising of the limbal based partial-thickness sclera flap. With at least a 3-month postoperative follow-up 10 out of 14 eyes had a final intraocular pressure of <18.5mmHg. 4 required additional subconjunctival 5-FU. The final visual acuity remained unchanged in 10 eyes while 3 recorded a worsening of visual acuity of more than 2 snellen lines due to progression of cataract. The postoperative complications included bleb breakdown and leakage, early and late bleb fibrosis, choroidal detachment and chronic hypotony. Neither endophthalmitis nor extinction phenomenon was recorded in our study. Trabeculectomy with intra-operative application of 5-FU is relatively safe and effective but a larger study with a longer follow-up is required to determine the long-term success rate nd complications of this technique.

Nigerian Journal of Ophthalmology Vol. 8, No.1 (August 2000): pp 21-28

KEY WORDS: 5-Fluorouracil, Nigeria, open-angle glaucoma, trabeculetomy.