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5-FU helps IOP remain lower in Asian eyes during trabeculectomy, surgeon says
Trial results highlight importance of understanding wound healing in different races.
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SINGAPORE – Using 5-fluorouracil during trabeculectomy in Asian eyes helped IOPs to remain significantly lower than when surgeons did not use the intraoperative application, said Steve Seah, MMed, FRCS, FRCOphth. He presented results from a long-term, prospective, randomized, double-masked trial in Singapore during the Asia-Pacific Academy of Ophthalmology meeting.
In addition to demonstrating the effectiveness of 5-fluorouracil (5-FU) in Asian eyes, the study highlighted the importance of glaucoma research in the East Asian population, which accounts for half of the world’s glaucoma sufferers, according to Dr. Seah.
The 5-FU trial, conducted through the Singapore National Eye Centre and the Singapore Eye Research Institute, was the sister study to similar research conducted at London’s Moorfields Eye Hospital.
“By far, this is the largest long-term glaucoma surgery trial in Asia,” he said.
The trial included 235 patients assigned to either a 5-minute application of 50 mg/mL of 5-FU (115 patients) or placebo (120 patients) during trabeculectomy. Mean patient age was 61 for the 5-FU group and 62 for the placebo group. Mean baseline IOP was 25 mm Hg for the 5-FU group and 24 mm Hg for the placebo group.
Success at low IOP threshold
Dr. Seah said success was defined as IOP of less than 14 mm Hg, 17 mm Hg or 21 mm Hg on two separate post- op occasions. Of the patients in the 5-FU group, 83 had an IOP greater than 14 mm Hg, compared with 101 of the 120 patients in the placebo group, making the failure rate significantly lower in the 5-FU group, he said.
The 5-FU patients in the 17 mm Hg and 21 mm Hg groups did better than the placebo group, but this did not reach statistical significance, Dr. Seah said.
Progression of visual field loss, disc deterioration and mean IOPs were better in the 5-FU group than the placebo group, but these too did not reach statistical significance.
“5-FU is a valuable agent in the augmentation of trabeculectomy in East Asians. But the significance of this trial goes beyond the efficacy of 5-FU augmentation in glaucoma filtration surgery,” Dr. Seah said.
He said the study will enhance future analyses of the natural history of trabeculectomy, as well as the relationship between IOP and disc/field progression in Asian populations.
Dr. Seah and colleagues in Singapore and the U.K. have not only been collaborating on the 5-FU trials, but they also have been analyzing the influences of race on the efficacy of trabeculectomy surgery.
“We know that there is an added difference between the wound healing response for different races,” Dr. Seah told the audience.
For more information:
- Steve Seah, MMed, FRCS, FRCOphth, can be reached at the Excellence Healthcare Pte. Ltd., 1 Orchard Blvd., #16-01, Camden Medical Center, Singapore 248649; +65-65-656-888; fax: +65-65-659-988; e-mail: snecss@pacific.net.sg; Web site: www.steveseah.com.
Reference:
- Husain R, Clarke JC, et al. A review of trabeculectomy in East Asian peoplethe influence of race. Eye. 2005;19(3):243-252.
- Jared Schultz is an OSN Staff Writer who covers all aspects of ophthalmology. He focuses geographically on Europe and the Asia-Pacific region.