5-FU with trabeculectomy helps to lower IOP long term in Asian glaucoma patients

Ophthalmology. 2009;116(2):175-184.

A prospective, randomized trial that examined use of adjunctive 5-fluorouracil with trabeculectomy surgery in an East Asian population found that IOP was reduced with limited complications.

The Singapore 5-Fluorouracil Trabeculectomy Study examined 243 Asian patients who had primary open-angle glaucoma or primary angle-closure glaucoma; 228 patients completed 3 years follow-up.

All patients in the double-masked study underwent trabeculectomy and were randomized to receive intraoperative 5-FU or a saline placebo in one eye during the procedure. The study's primary outcome measure was IOP, while secondary outcome measures were visual field loss progression, number of adverse events and interventions needed after surgery.

Researchers found that fewer patients in the 5-FU group failed the trial based on predetermined IOP. The difference in the failure rate was only significant with a failure criterion of IOP greater than 17 mm Hg (P = .0154).

"The trial shows that an increased success rate can be achieved for several years after a single intraoperative treatment with 5-FU," the study authors said. "We conclude that 5-FU is relatively safe and can be routinely used in low-risk East Asian patients."

They also found no significant difference in progression of optic disc or visual field loss in the 5-FU and placebo groups at 36 months. However, uveitis occurred more often in the 5-FU group, but it did not affect IOP-lowering effects or long-term outcomes.