The role of 5-fluorouracil in complicated glaucomas.

The long-term efficacy of trabeculectomy in controlling intraocular pressure (IOP) has been found unsatisfactory in various complicated and refractory glaucomas. The most common cause for failure is excessive scarring at the filtering site. Several wound modulating agents which reduce scarring have been tested. In this study, 5-Fluorouracil (5-FU), a halogenated pyrimidine analogue and a potent anti-mitotic agent, was applied for seven days after trabeculectomy in eighteen complicated and unsuccessful filtering glaucomas, at a daily dosage of 5 mg in the form of 0.5 ml subconjunctival injections. The common postoperative complications encountered were corneal epithelial erosion (38%), wound leakage (16%), subconjunctival haemorrhage (32%) and hyphaema (10%), all during the first 7 to 10 days. Monitoring at regular intervals up to six months showed adequate control of IOP (less than 22mm Hg.) in 88% of the cases. Cases of aphakic glaucoma and neovascular glaucoma showed poor response. Use of 5-FU as an adjuvant to filtering surgery in various complicated glaucomas improves the long-term results.

Comparative results of limbal based versus fornix based conjunctival flaps for trabeculectomy.

Among 100 cases of primary glaucomas, 50 cases were operated for trabeculectomy by making fornix based flap and 50 cases were operated by fashioning limbal based conjunctival flap. Operative and post operative complications were studied thoroughly in the two groups. All the cases were followed up for six months to one year to assess control of intra ocular pressure, nature and functioning of filtering bleb, field changes and visual status in the two groups. It was found that the fornix based flap is much superior and carries various advantages over the limbal based flap. The operative and post operative complications are minimum in the fornix based flap as compared to the limbal based flap.