Abstract
Abstract: :
Purpose: To compare the efficacy & safety of adjunctive 5–Fluorouracil (5–FU) versus Mitomycin (MMC) in bleb needling for failing filters after trabeculectomy. Methods: Slit–lamp external bleb needling was performed for failing filters in 86 consecutive patients. Adjunctive 5–FU (10 mg) was injected in 36 patients & adjunctive MMC (20 ug) in 50 patients at least 20 minutes prior to the needling procedure.When required, multiple needlings/antimetabolite injections were given. Pre–and post–needling intraocular pressure (IOP) and medications, success rate (IOP less than 18 mm Hg without medications & greater than 30% IOP reduction) and complications were compared. Results: Mean pre–and post–needling IOP was similar between those patients who received adjunctive 5–FU (24.1 to 15.7 mm Hg) or MMC (24.5 to 14.2 mm Hg). Patients who were needled with 5–FU required an average of 2.8 needlings versus those who received MMC (average 1.1) p=0.001. After a mean follow–up post–needling of 12.6 months, complete success was 48.7% in the 5–FU group versus 70.0% in the MMC group. Major complications included 3 patients with persistent hypotony requiring intervention and 1 patient develolped a post–needling suprachoroidal hemorrhage. Conclusions: MMC appears to provide improved efficacy when compared versus 5–FU as an adjunct to needling of failing blebs after trabeculectomy, requiring fewer repeat needlings and a superior success rate.
Keywords: wound healing • intraocular pressure • clinical (human) or epidemiologic studies: outcomes/complications