Primary trabeculectomy with 5-fluorouracil for glaucoma secondary to uveitis

Abstract

Raised intraocular pressure occurs in a significant proportion of patients with uveitis, and may lead to glaucomatous visual loss. Medical therapy often proves inadequate in controlling intraocular pressure, necessitating surgical intervention but conventional filtering procedures such as trabeculectomy are known to fail more frequently in this group than in non-inflamed eyes. Adjunctive subconjunctival 5-fluorouracil (5-FU) has been shown to improve the success of trabeculectomy in a variety of secondary glaucomas. This retrospective study examined the effect of postoperative 5-FU administration on the outcome of trabeculectomy in uveitis-related glaucoma in 28 eyes of 26 patients. Eyes treated with adjunctive 5-FU showed a more prolonged control of intraocular pressure, and a longer median time to failure of control than untreated eyes. Trabeculectomy failure was more common and occurred earlier when a limbus-based conjunctival flap had been used, in patients of black ethnic origin, and if there had been previous intraocular surgery. Additional hypotensive therapy with topical ß-blockers was required more frequently in eyes which had not received 5-FU, and where a limbus-based conjunctival flap had been employed, all eyes in the latter group requiring ß-blockers one year after surgery. Intraocular inflammation was under satisfactory control in all patients at the time of surgery, and no deleterious effect on control of uveitis in relation to surgical intervention was observed.