AIMS: To evaluate the efficacy of intra-operative sponge
5-fluorouracil(5-FU)combined with post-operative 5-FU needling of the bleb in
patients at risk for trabeculectomy failure.
METHODS:Case notes of twenty-seven eyes which underwent augmented
trabeculectomy with releasable sutures. 5-FU needling revision of the bleb was
undertaken after suture release failed to achieve satisfactory intra-ocular
pressure (IOP) control.
RESULTS: Mean period of follow-up was 81.5(sd 37)weeks.The pre-operative mean
IOP was 34.26mmHg (sd 6.01)mmHg compared to 17.54 (sd 4.84)mmHg
post-operatively (p<0.001; paired Student's t-test). 88.5% achieved IOP of
22mmHg or less with or without medication. Ten eyes (38.5%)required no
medication and 13 eyes (48.1%) achieved an IOP of less than 16mmHg. There was a
37% reduction in the number of medications post-operatively. There was a mean
2.38 (sd 0.5) needlings per eye with a cumulative injected dose of 11.5 (sd
7.5)mg. The complication rates related to surgery and bleb needling were 59.3%
and 44.4% respectively. These were mostly corneal and conjunctival defects and
resolved without sequelae.
CONCLUSIONS: Intra-operative sponge 5-FU combined with 5-FU needling
revision of the bleb is a reasonable strategy in the management of patients at
risk of trabeculectomy failure. This is accomplished without the tedium of
daily painful injections and with a lower cumulative dose of 5-FU than used in
previous clinical studies.