5-FLUOROURACIL INJECTION AFTER FILTERING SURGERY

Background Since 1984 subconjunctival 5-Fluorouracil injections have b een applied with success after filtering surgery. It was the purpose o f this retrospective study to find out whether the results justify thi s treatment in view of all side effects. Materials and Methods Between 2/1991 and 1/1993 twenty-nine eyes of 11 female and 16 male patients with high-risk glaucoma (unsuccessful previous filtering surgery and a high risk of scarring) were treated with subconjunctival injections o f 5-Fluorouracil after filtering surgery in the University Eye Hospita l Dusseldorf. The mean age of the patients was 58 (11-84) years and th e mean follow-up period was 16 (4-24) months. The mean amount of injec ted 5-Fluorouracil was 43 (5-85) mg. Glaucoma was regarded as controll ed when intraocular pressure levels were reduced by more than 20% of t he preoperative level and stayed consistantly below 21 mm Hg. Results 26 (89,6%) of the eyes had controlled intraocular pressure during the follow-up period. Two eyes were controlled only after additional cyclo crycoagulation, and 1 glaucoma has remained uncontrolled. Postoperativ ely we observed fistulas of the conjunctiva in 24% of the eyes and 69% of the eyes had corneal epithelial breakdown problems. It is unlikely that subconjunctival injections of 5-Fluorouracil work only by inhibi ting scarring of the filtration bleb. Long-lasting e-vacuo-symptoms in single cases with no functioning bleb at all as well as scarred blebs in 9 of 26 eyes with controlled glaucoma must be interpreted as a pro bable sign of 5-Fluorouracil toxicity on the ciliary epithelium. Concl usions Subconjunctival injections of 5-Fluorouracil after filtering su rgery are helpful to control high-risk glaucoma, but there are several disadvantages of this treatment as fistulas of the conjunctiva, corne al surface problems, discomfort for the patient, difficult follow-up a nd a potential toxicity on the ciliary epithelium that may be pronounc ed in some cases. Therefore, subconjunctival injections of 5-Fluoroura cil after filtering surgery are a useful means for eyes with a high ri sk of scarring. However, 5-Fluorouracil should not be applied for prim ary normal glaucoma surgery.