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R. A. Dalvi, N. Orzych, C. Kranemann, C. Birt; 5 Year Follow Up of 5-FU Augmented Needling Revision of the Failing Bleb: A Case Control Study. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4156.
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To report the 5-year intraocular pressure outcomes of patients who underwent a 5-fluorouracil (5-FU) needling revision to their trabeculectomy bleb compared to a matched sample of patients who did not require a bleb needling.
The study was a retrospective, observational, case - control series. A cohort of 40 eyes that received a 5-FU augmented bleb needling revision were age, gender and race-matched to 40 patients who did not receive a bleb needling. The data were collected for a period of 5 years following the original surgery. IOP was recorded preoperatively and 1 week postoperatively, prior to and immediately following the 5-FU needling (when performed), and annually to 5 years postoperatively. Outcome measures were pre needling and post needling IOP, pre needling and post needling medications and post needling course (including complications and any need for additional surgery). A complete success was defined as IOP control without medication use or further surgical intervention; a qualified success was defined as IOP control with the addition of medications or a further 5-FU needling but no surgery.
At the end of five years the mean IOP decreased significantly in both groups, from 26.98 mmHg ± 8.38 prior to the original surgery to 16.14 mmHg ± 5.98, a drop of 10.84 mmHg (40.17 %).in the 5-FU group (t = 7.21, p < 0.005) and from 24.21 mmHg ± 8.71 to 16.28 mmHg ± 7.83, a drop of 7.93 (32.75 %) in the control group (t= 4.18, p < 0.005). The difference between the two groups at five years was not statistically significant.(t =-0.20, p > 0.05). In the 40 patients that received the 5-FU needling the mean IOP was 25.53 ± 9.07 mm Hg before needling and 11.97 ± 6.08 mm Hg immediately following the procedure. This difference was highly statistically significant, (t = 7.42, p<0.00001). 8 patients (20%) in the 5FU group required subsequent surgery vs. 4 pts (10 %) in the control group. (Χ2 = 1.57, p > 0.05). 32 patients (80.0%) in the 5-FU group required anti-glaucoma medication postoperatively vs. 28 patients (70%) in the control group (Χ2 = 0.600. p > 0.05). 32 patients in the 5 FU group had a outcome defined as either a complete or a qualified success compared to 36 patients in the control group. This difference was not statistically significant (Χ2 = 0.88 p=0.34).
The use of 5-FU can significantly lower IOP in the failing filtration bleb, resulting in long term IOP control similar to those who did not require the procedure. No statistically significant differences between the two groups was seen in the rate of restarting medications or in the rates of surgical failure.
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