Purpose: To compare
retrospectively long-term effectiveness of different antimetabolites in the
surgical treatment of neovascular glaucoma (NVG). Methods: from 1989 to 1997, 20 eyes of 20 consecutive
NVG-affected patients (mean age 61,4±9.6) underwent trabeculectomy, after
previous peripheral retinal ablation: 9 eyes (5-FU group) received
postoperative subconjunctival 5-Fluorouracil; 11 eyes (MMC group) received
intraoperative low-dose Mitomycin C and
postoperative 5-FU only in case of
IOP>21 mmHg. Results:
After a mean follow-up of 34.9 ± 38.4 months, overall IOP decreased from
41,3 ± 10.6 to 19,2 ± 10.7 mmHg (-53.7% from baseline, p<0.0001). In the
5-FU group, IOP decreased from 40.4±10.3 to 14.7±3.4 mmHg (p<0.0001). In the
MMC group, only 1 eye had a postoperative IOP <21mmHg with MMC alone; in 10
eyes it was necessary to administer postoperative 5-FU; after this, IOP
decreased from 42±11.3 to 22.9±13.3mmHg (p<0.0006); the difference among
groups wasn’t significant. Complete success (IOP <21 mmHg without medical
therapy) was obtained in 10 patients (52,6%), qualified success (IOP <21 mm
Hg with medical therapy) was obtained in 5 patients (26,3%). In the 5-FU group,
total success rate was 100% (75% complete, 25% qualified); in the MMC group,
total success rate was 63,6% (36,3% complete, 27,3% qualified). 5-FU mean dose
was 36.6 ± 18.7 mg in the 5-FU group, and 28.3±25 mg in the MMC group (p=0.31).
Conclusions: In patients who underwent trabeculectomy for NVG, intraoperative
low-dose administration of MMC doesn’t seem to be more effective than the
postoperative administration of 5-FU.