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Abstract #6111 Published in IGR 2-2
Glaucoma surgery with or without adjunctive antiproliferatives in normal tension glaucoma: 1. Intraocular pressure control and complications
Membrey WL; Poinoosawmy DP; Bunce C; Hitchings RABritish Journal of Ophthalmology 2000; 84: 586-590
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: Eighty-six eyes of 73 white NTG patients who had undergone a primary guarded fistulising procedure were reviewed. Twenty-five 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 two years) compared with either the 5-FU group (69.4% at two years, p = 0.01) or the MMC group (64.9% at two 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 two years) compared with those that had adjunctive 5-FU (14.7% by two years), p = 0.06. CONCLUSIONS: 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.
Dr. W.L. Membrey, Glaucoma Unit, Moorfields Eye Hospital, London, UK
Classification:
9.2.4 Normal pressure glaucoma (Part of: 9 Clinical forms of glaucomas > 9.2 Primary open angle glaucomas)
12.8.10 Woundhealing antifibrosis (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
