Glaucoma surgery with or without adjunctive antiproliferatives in normal tension glaucoma: 1 Intraocular pressure control and complications

Background-Reduction of intraocular pressure (IOP) by 20-30% with glaucoma drainage surgery slows disease progression in normal tension glaucoma (NTG) . It is not clear whether adjunctive antiproliferative agents are necessary or safe in eyes at low risk for scarring. Method-86 eyes of 73 white NTG patients who had undergone a primary guarded fistulising procedure were reviewed. 25 eyes had no antiproliferatives, 36 had peroperative 5-fluorouracil (5-FU) and 25 had peroperative mitomycin C (MMC). Their postoperative IOPs, complications, and changes in visual acui ty were recorded. Results-Eyes that had no adjunctive antiproliferative less commonly maintai ned a 20-30% reduction in IOP (47.4% at 2 years) compared with either the 5 -FU group (69.4%at 2 years, p=0.01) or the MMC group (64.9% at 2 years, p=0 .04). Eyes that had adjunctive MMC more often had late hypotony (28%, p=0.0 2) and late bleb leak (12%, p<0.001). Eyes that had adjunctive MMC also mor e often had a two lines loss of Snellen visual acuity (39.8% by 2 years) co mpared with those that had adjunctive 5-FU (14.7% by 2 years), p=0.06. Conclusion-For NTG patients at low risk of scarring trabeculectomy with adj unctive peroperative 5-FU should maintain a suitable target IOP without the additional sight threatening complications seen with adjunctive MMC.