The efficacy and safety of intraoperative and/or postoperative 5-fluorouracil in trabeculectomy and phacotrabeculectomy

Purpose : First, to assess the safety and efficacy of using 5‐fluorouracil (5‐FU) to improve trabeculectomy and phacotrabeculectomy success rates, and second, to assess the efficacy of intraoperative and reduced postoperative 5‐FU following trabeculectomy compared with a more intensive course of postoperative 5‐FU alone. Methods : In a retrospective, unmatched, non‐randomized consecutive series study, 186 eyes of 186 patients who had filtration surgery were followed for 2 years in four groups: 51 patients had undergone trabeculectomy surgery with postoperative 5‐FU, 51 had phacotrabeculectomy with postoperative 5‐FU, 56 had trabeculectomy with both intraoperative and postoperative 5‐FU, and 28 patients had trabeculectomy without antifibrotics. Results : At all times mean intraocular pressure (IOP) was reduced in all groups (P < 0.001 for each group). Success was defined as IOP < 16 mmHg and > 30% IOP reduction at the 2‐year follow up. It was achieved in 71% of the trabeculectomy patients with intraoperative and postoperative 5‐FU, 76% of the trabeculectomy group with only postoperative 5‐FU, 55% of the phacotrabeculectomy/ 5‐FU group, and in 29% of the trabeculectomy‐only eyes (between‐group differences P < 0.01). Success rates were not significantly different for the intraoperative and postoperative 5‐FU trabeculectomy versus the postoperative 5‐FU‐only eyes, but the former had fewer postoperative 5‐FU injections and corneal ulceration (P < 0.01 for both). Conclusions : 5‐Fluorouracil was safe and improved trabeculectomy survival. Intraoperative 5‐FU allowed fewer postoperative 5‐FU injections and fewer side‐effects without compromising success rates. Phacotrabeculectomy with postoperative 5‐FU had a lower surgical success rate than did trabeculectomy with 5‐FU and this was not statistically different from trabeculectomy without 5‐FU.