Weinreb R N
Ophthalmology. 1987 May;94(5):564-70. doi: 10.1016/s0161-6420(87)33430-x.
The antimetabolite 5-fluorouracil (5-FU) was used as adjunctive treatment in glaucomatous eyes with poor prognoses undergoing filtering surgery. By adjusting the frequency of postoperative 5-FU subconjunctival injections according to the clinical response, the author thought it might be possible to reduce episcleral fibroproliferation and maintain a patent filter while reducing complications. Sixty-three eyes underwent filtering surgery with subsequent subconjunctival injections of 5.0 to 7.5 mg 5-FU for 14 days. The antimetabolite was not administered if there was evidence of corneal toxicity as demonstrated by epithelial defects or filaments, flat anterior chamber, or a conjunctival wound leak. By adjusting the injections in this fashion, the total amount of 5-FU administered ranged between 17.5 and 62.5 mg (34.4 +/- 11.6 mg). After 1 year, successful surgical outcomes were observed in 13/15 eyes with aphakia (87%), 11/17 eyes with neovascular glaucoma (65%), 11/12 eyes with at least two previous failed filters (92%), and 5/6 eyes with inflammatory glaucoma (83%). Eyes with epithelial downgrowth and cicatrizing diseases of the conjunctiva also were treated. Overall, conjunctival wound leaks were observed in 24% of the eyes and 29% had detectable changes in their corneal epithelium with corneal defects and filaments. Although adjusting the dose of 5-FU appears to be safe and effective, this can be determined clearly only by a controlled randomized clinical trial.
抗代谢药物5-氟尿嘧啶（5-FU）被用作辅助治疗，用于接受滤过手术但预后不良的青光眼患者。根据临床反应调整术后5-FU结膜下注射的频率，作者认为有可能减少巩膜下纤维增生，维持滤过通道通畅，同时减少并发症。63只眼睛接受了滤过手术，随后结膜下注射5.0至7.5毫克5-FU，持续14天。如果出现角膜毒性迹象，如上皮缺损或丝状物、前房变浅或结膜伤口渗漏，则不使用抗代谢药物。通过这种方式调整注射剂量，5-FU的总给药量在17.5至62.5毫克之间（34.4±11.6毫克）。1年后，在15只无晶状体眼中有13只（87%）观察到手术成功，17只新生血管性青光眼眼中有11只（65%），至少有两次滤过失败的12只眼中有11只（92%），6只炎症性青光眼眼中有5只（83%）。伴有上皮内生和结膜瘢痕性疾病的眼睛也接受了治疗。总体而言，24%的眼睛观察到结膜伤口渗漏，29%的眼睛角膜上皮有可检测到的变化，出现角膜缺损和丝状物。虽然调整5-FU的剂量似乎安全有效，但这只有通过对照随机临床试验才能明确确定。
