EARLY AND LATE POSTOPERATIVE APPLICATION OF 5-FLUOROURACIL FOLLOWING TRABECULECTOMY IN REFRACTORY GLAUCOMA

Intraocular pressure (IOP) control was studied retrospectively in two groups of 14 consecutive patients following trabeculectomy with adjunc tive postoperative 5-fluorouracil (5-FU) treatment. In one of the grou ps (the early-treatment group), 5-FU injections were started 2.4 +/- 0 .6 days postoperatively; in the other group (the delayed-treatment gro up), they were started only when clinical signs suggested impending bl eb failure (12.6 +/- 5.4 days postsurgery). The patients in the two gr oups were age-matched and had a similar history of previous failed gla ucoma operations or diabetes, both of which are considered indications for postoperative 5-FU injections. The mean number of 5-FU injections and the total dose in the two groups did not differ significantly (5. 3 +/- 0.8 and 5.5 +/- 1.1 injections, respectively; 26.4 +/- 3.9 and 2 7.5 +/- 5.3 mg 5-FU total dose, respectively). The average follow up f or the two groups was 16.6 +/- 2.5 and 16.9 +/- 2.7 months, respective ly. With an IOP of 18 mm Hg or less with or without medications consid ered a success, 42.8% of the delayed-treatment and 71.4% of the early- treatment cases were successful. More medications were required in the early-treatment group. Postoperative transient corneal epithelial def ects occurred in 71.4% and 78.4% of the eyes in the late- and early-tr eatment groups, respectively, an insignificant difference. Conjunctiva l wound leak occurred in one patient (in the delayed-treatment group). These results suggest that application of 5-FU at a relatively late p ostoperative point (more than 10 days after surgery), based on clinica l evidence of impending bleb failure, can still effectively control IO P, although to a lesser degree than application at an earlier point po stoperatively. Thus, in cases with impending bleb failure, 5-FU applic ation may be advisable even at a relatively late point after surgery.