The role of antimetabolites in filtration surgery for neovascular glaucoma: intermediate‐term follow‐up

Abstract

Abstract. Purpose: To compare the intermediate‐term efficacy of 5‐fluorouracil (5‐FU) and Mitomycin C (MMC) as adjunctive antimetabolites in neovascular glaucoma (NVG) filtration surgery. Methods: Forty consecutive eyes of 40 patients with NVG refractory to medical therapy were randomized to receive antimetabolite‐augmented trabeculectomy. Eighteen eyes received postoperative 5‐FU (5‐FU group) and 22 eyes received intraoperative, low‐dose (0.2 mg/ml) MMC for 2 mins (MMC group). The main outcome measure was intraocular pressure (IOP). Surgical success was defined as IOP < 21 mmHg with topical treatment (qualified success) or without topical treatment (complete success). Surgical failure was defined as IOP ≥ 21 mmHg, despite postoperative topical treatment, and by postoperative blindness. Results: The mean follow‐up period was 35.8 ± 22.6 months in the 5‐FU group and 18.6 ± 17.2 months in the MMC group. This difference was not significant. Mean IOP decreased from 40.4 ± 10.3 mmHg to 14.7 ± 3.4 mmHg (p < 0.0001) in the 5‐FU group and from 42 ± 11.3 mmHg to 22.9 ± 13.3 mmHg (p = 0.0006) in the MMC group; however, the difference between the 5‐FU and MMC groups was not significant at any point. The success rate in the 5‐FU group was 55.5% (44.4% complete, 11.1% qualified), compared with 54.5% (9.1% complete, 45.4% qualified) in the MMC group. This difference was not significant. Conclusions: The percentage of patients who achieved postoperative IOP < 21 mmHg was similar in both groups, although a larger proportion of patients treated with MMC‐augmented trabeculectomy required topical treatment in comparison with the 5‐FU group.