MITOMYCIN-C VERSUS 5-FLUOROURACIL IN HIGH-RISK GLAUCOMA FILTERING SURGERY

Purpose: To compare the outcome of filtering surgery in high-risk pati ents using intraoperative mitomycin C (MMC) versus postoperative 5-flu orouracil (5-FU). Methods: In a randomized clinical trial, the use of postoperative subconjunctival injections of 5-FU in 19 eyes of 19 pati ents was compared with a single intraoperative application of MMC in 2 0 eyes of 20 patients. All eyes were at high risk for failure of glauc oma filtering surgery. Results: Follow-up ranged from 26 to 38 months (mean, 32.0 months). Three eyes in the MMC-treated group and two eyes in the 5-FU-treated group required subsequent surgery to control the I OP. Excluding these patients, intraocular pressure (IOP) averaged 9.0 +/- 4.9 mmHg in the MMC-treated eyes versus 16.3 +/- 4.6 mmHg in the 5 -FU-treated eyes at the patient's last visit (P = 0.0003). Of the MMC- treated eyes, 81.3% had IOPs less than or equal to 12 mmHg compared wi th 26.7% of eyes in the 5-FU group (P = 0.0023). In the MMC-treated gr oup, the average number of medications for IOP control at last visit w as 0.5 +/- 0.8 compared with 1.6 +/- 1.3 in the 5-FU-treated group (P = 0.01). Late postoperative complications (those occurring more than 3 months after surgery) were similar for the two groups, with the excep tion of formation of a Tenon cyst in three of the eyes treated with MM C compared with none of the 5-FU-treated eyes. Conclusions: Eyes treat ed with MMC have lower IOP on fewer medications than eyes treated with 5-FU. Late postoperative complications are similar with the exception of an increased incidence of Tenon cyst formation in the MMC-treated eyes.