A randomised trial of the effect of intraoperative 5-FU on the outcome of trabeculectomy in east Africa

Aims-To determine if intraoperative application of 5-fluorouracil (5-FU) im proves the prognosis for trabeculectomy in east Africa. Methods-68 eyes with chronic open angle glaucoma were included in a randomi sed trial of intraoperative 5-FU versus placebo. Main outcome measures were intraocular pressures at 6 months and probability of failure at 2 years. Results-180 days after surgery the mean intraocular pressure (IOP) was 17.4 (SD 6.1) mm Hg in the placebo group and 16.9 (5.8) mm. Hg in the 5-FU grou p. By 2 years after trabeculectomy, the probability of successful IOP contr ol was 70.6% in the placebo group, and 88.8% in the 5-FU group. The placebo group was 2.18 times (95% CI 0.67 to 7.15) more likely to require addition al IOP lowering procedures than the 5-FU group. Among patients followed for 2 years, 30% lost 0.3 logMAR units of visual acuity. Conclusions-Trabeculectomy in Africa has an acceptable success rate which m ay be enhanced by the use of intraoperative 5-FU. It is estimated that this would cost approximately pound1.25 per trabeculectomy failure prevented.