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H. Kim, P. R. Egbert, K. Singh; Long Term Comparison of Primary Trabeculectomy With 5-Fluorouracil versus Mitomycin C in West Africa. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4540.
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To compare the long term efficacy and safety of intraoperative 5-fluorouracil (5-FU) versus mitomycin-C (MMC) used adjunctively with primary trabeculectomy in a Black West African population.
Review of 68 eyes of 68 Black West African subjects that underwent primary trabeculectomy in Cape Coast, Ghana with the use of intraoperative 5-FU or MMC between January 1, 1988 and January 1, 2002 and had at least three years postoperative follow-up. Postoperative outcome measures included intraocular pressure (IOP) control, number of glaucoma medications, visual acuity, and complications. The data were analyzed using the Mann-Whitney- Wilcoxon, Fisher’s Exact, or Pearson Chi Square test.
38 of 68 eyes received 5-FU and 30 received MMC. Mean postoperative follow-up was 7.5 and 6.5 years in the 5-FU and MMC groups respectively (p=0.17). A higher proportion of eyes in the MMC group achieved "qualified" (with or without IOP lowering therapy) postoperative success with varying IOP targets relative to the 5-FU group, but the differences were not statistically significant. The greatest difference between 5-FU and MMC was seen when success was defined as IOP less than 21 mm Hg (52.6% vs. 73.3%, respectively, p = 0.07). "Complete" (without IOP lowering therapy) postoperative success was greater in the MMC group with a significantly higher proportion achieving an IOP less than 21 mm Hg (p=0.02). MMC use was also associated with a lower likelihood of receiving IOP lowering medications postoperatively (p=0.01). Baseline demographic characteristics, preoperative and postoperative IOP, visual acuity and complications did not differ significantly between the two groups.
Intraoperative MMC use is associated with a lower likelihood of requiring postoperative medications and a greater likelihood of achieving IOP lowering without medications relative to intraoperative 5-FU use in a Black West African population.
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