Goldenfeld M, Krupin T, Ruderman J M, Wong P C, Rosenberg L F, Ritch R, Liebmann J M, Gieser D K
Department of Ophthalmology, Northwestern University, Chicago, Illinois.
Ophthalmology. 1994 Jun;101(6):1024-9. doi: 10.1016/s0161-6420(94)31223-1.
Postoperative subconjunctival 5-fluorouracil (5-FU) injections increase the success of filtration surgery in eyes with prior filtration failure or cataract removal and in eyes with secondary glaucoma. The authors evaluate the safety and benefit of adjunctive 5-FU in eyes undergoing initial trabeculectomy.
Patients with phakic, uncontrolled, open-angle glaucoma who were undergoing initial trabeculectomy were prospectively assigned to the 5-FU group on the first postoperative day. Patients in this group received five 5-mg injections during 2 weeks after surgery. Patients in the control group received no injections.
Preoperative intraocular pressure (IOP) and number of antiglaucoma medications were similar in the 5-FU (n = 32) and control (n = 30) groups. Transient superficial punctate keratopathy was the only postoperative complication that occurred more frequently (P < 0.05) in the 5-FU (14 eyes) than in the control eyes (3 eyes). Patients were followed for a minimum of 1 year or until a study endpoint was reached: IOP of 21 mmHg or greater with maximum medical therapy (2 5-FU eyes and 8 control eyes; P < 0.03) or cataract removal after filtration (5 treated and 3 control eyes). At last follow-up (mean, > 20 months), IOP and the number of antiglaucoma medications were significantly lower (P < 0.02) in the 5-FU eyes (IOP, 12.0 +/- 1.3 mmHg; medications, 0.2 +/- 0.1) than in the control eyes (IOP, 16.8 +/- 1.3 mmHg; medications, 0.8 +/- 0.2). Intraocular pressure was 20 mmHg or lower in 94% of 5-FU eyes and in 73% of control eyes (P < 0.03) and 16 mmHg or lower in 84% of 5-FU eyes and in 57% of control eyes (P < 0.02).
Adjunctive 5-fluorouracil increases the rate of success, decreases the level of postoperative IOP, and reduces the need for postoperative antiglaucoma medication in eyes with open-angle glaucoma undergoing initial trabeculectomy.
对于既往滤过手术失败或行白内障摘除术的眼睛以及继发性青光眼患者，术后结膜下注射5-氟尿嘧啶（5-FU）可提高滤过手术的成功率。作者评估了辅助使用5-FU在初次小梁切除术患者眼中的安全性和益处。
将正在接受初次小梁切除术的有晶状体、眼压控制不佳的开角型青光眼患者在术后第1天前瞻性地分配至5-FU组。该组患者在术后2周内接受5次5毫克的注射。对照组患者不接受注射。
5-FU组（n = 32）和对照组（n = 30）的术前眼压（IOP）和抗青光眼药物使用数量相似。短暂性浅层点状角膜病变是唯一在5-FU组（14只眼）中比对照组（3只眼）更频繁出现的术后并发症（P < 0.05）。患者至少随访1年或直至达到研究终点：最大药物治疗下眼压≥21 mmHg（5-FU组2只眼，对照组8只眼；P < 0.03）或滤过术后行白内障摘除术（5-FU组5只眼，对照组3只眼）。在最后一次随访时（平均>20个月），5-FU组患者的眼压和抗青光眼药物使用数量显著低于对照组（P < 0.02）（5-FU组眼压为12.0±1.3 mmHg；药物使用数量为0.2±0.1；对照组眼压为16.8±1.3 mmHg；药物使用数量为0.8±0.2）。5-FU组94%的眼睛眼压≤20 mmHg，对照组为该比例为73%（P < 0.03）；5-FU组84%的眼睛眼压≤16 mmHg，对照组为57%（P < 0.02）。
辅助使用5-氟尿嘧啶可提高初次小梁切除术治疗开角型青光眼的成功率，降低术后眼压水平，并减少术后抗青光眼药物的使用需求。
