Year : 1993 

|  Volume : 41  |  Issue : 4  |  Page : 185-186

Incidence of complications following 5-fluorouracil with trabecule

Ophthalmology, Christian Medical College, Vellore, India

Correspondence Address:Ravi ThomasSchell Eye Hospital, Vellore, Tamil Nadu 632 001 India

PMID: 8005651

    Abstract
To investigate the incidence of complications reportedly caused by the use of 5-fluoroura
patients with advanced glaucoma. The mean preoperative intraocular pressure was 34.8
followed by shallowing of the anterior chamber (12%), choroidal detachment (9%), and fl
subepithelial scarring, or striate melanokeratosis which are usually described with the us
without hypotensive therapy were achieved in 73.7% of cases, and less than 21 mm Hg
success rate, we recommend the use of 5-FU in routine glaucoma filtering surgery

Keywords: Trabeculectomy - 5-FU - Complications

How to cite this article:

Thomas R, Jacob A, Raju R, Gieser SC, Sen S. Incidence of complications following 5-fluoroura

How to cite this URL:

Thomas R, Jacob A, Raju R, Gieser SC, Sen S. Incidence of complications following 5-fluoroura
from: http://www.ijo.in/text.asp?1993/41/4/185/25596

Conjunctival scarring due to fibroblast proliferation is the major cause of failure of filtratio
the formation of filtering blebs. [3],[4] However, since it affects cellular replication, it has ad

A survey of the literature indicates a high incidence of corneal complications, conjunctiva

undertook this study to investigate the incidence of complications caused by the use of 5
    Materials and methods

All patients who underwent trabeculectomy with 5-FU between November 1988 and May
of 56 patients underwent surgery. All patients had a fornix-based conjunctival flap and a

Postoperatively, all patients were placed on homatropine 2% and betamethasone drops,

Five milligram of 5-FU in a volume of 0.1 ml was injected subconjunctivally, 180° away fr
injections per patient, but the actual number given was titrated according to the response

All patients were examined twice daily while in the hospital and then were usually seen a
special reference to the bleb and intraocular pressure measurement, the cornea was sta
deferred if complications such as significant superficial punctate keratopathy or grade 2 s

Intraocular pressures were measured using Goldmann applanation tonometer, anterior c

any persistent leakage from under the conjunctival flap or site of injection.

    Results

The mean preoperative intraocular pressure was 34.8 mm Hg. The mean intraocular pre
pressures of less than 16 mm Hg without hypotensive therapy was achieved in 73.7% of

The complications encountered are shown in the [Table - 1]. The most frequent complicati
typical confluent corneal epithelial lesions which are described as the most common com
conjunctival leaks persisting less than five days, which are expected with such flaps. Non

Shallowing of the anterior chamber was seen in 12% of cases, and choroidal detachmen
scarring, cicatricial ectropion, and lacrimal system obstruction were, however, not encou
not seen.

    Discussion

5-Fluorouracil is a fluorinated pyrimidine analogue that competitively inhibits thymidylate

to increase the success rate of trabeculectomies in aphakia or pseudophakia, neovascul

In our patients, the most common complication encountered was superficial punctate ker
potential risk of a wound leak, many authors recommend a limbus-based flap when using
were considered clinically insignificant and healed without intervention. We attribute this
edge thereby putting the flap on stretch and preventing a gross leak. Leakage is also loo
placed in the opposite edge of the conjunctival flap if necessary.
Shallow anterior chambers (12%) were of grade 1 or 2, and did not require surgical interv
postponed unless associated with a grade 2 shallow anterior chamber. The incidence of
to other reports [3][4][5] One patient developed a retinal detachment with a giant retinal tea
following the use of 5-FU but the association is likely to be incidentals

We did not encounter any case of confluent corneal epithelial defect or striate melanoker
corneal epithelium is desiccated and presumably more susceptible due to a combination
complications could also be attributed to the lower dose of 5-FU used, titration of dosage
complication was encountered.

While this study emphasizes the complications encountered due to the use of 5-FU, a co
hypotensive medications, a target pressure suitable for most glaucomatous eyes, was ac

In view of the absence of major complications, such as confluent corneal epithelial defec
recommend the use of 5-FU in routine glaucoma filtering surgery.

    References

1. Addicks EM, Quigley HA, Green WR, et al. Histologic characteristics of filtering
2. Skuta GL and Parrish RK II. Wound healing in glaucoma filtration surgery. Surv
3. Heur DK, Parrish RK, Gressel MG, et al. 5-Fluorouracil and glaucoma filtering s
4. Heur DK, Parrish RK, Gressel MG, et al. 5-Fluorouracil and glaucoma filtering s
5. Weinreb RN. Adjusting the dose of 5-Fluorouracil after filtration surgery to minim
6. Cairns JE. Trabeculectomy: preliminary report of a new procedure. Am J Ophth
7. Liebmann JM, Ritch R, Marmor M, et al. Initial 5Fluorouracil trabeculectomy in
8. Gupta A, Bansal RK, Grewal SPS, et al. 5-Fluorouracil as an adjuvant in glauco
9. Caravella LP, Burns JA, and Zangmeister M. Punctal canalicular stenosis relate

    Tables
[Table - 1]