Subconjuctival application of 5-fluorouracil (5-FU) following surgical treatment of glaucoma with deep sclerectomy – indications, complications and initial evaluation of efficacy

Introduction
5-FU is an antimetabolite which increases efficacy of deep sclerectomy by inhibiting subconjuctival fibrosis and fibroblast proliferation. The objective of the study was to analyze glaucoma patients who had undergone sclerectomy and in a post-surgery period required subconjuctival 5-FU injections.

Material and methods
Out of 120 patients who had undergone deep sclerectomy between January through November 2004, 17 were included in the study since they required subconjuctival 5-FU injections in a postoperative period. The analysis comprised of: (1) indications for antimetabolite administration; (2) time that elapsed from the surgery to the first antimetabolite administration; (3) mean dosage; (4) complications observed; and (5) initial evaluation of the treatment.

Results
In 13 patients (76.4%), the indication for 5-FU application was persistent intraocular pressure exceeding 15 mmHg; in one patient (5.8%), the 5-FU treatment was started due to an abrupt increase of the pressure from hypotony; in 6 subjects (35.2%), it was the thickening and vascular dilatation in the filtering bleb; in one subject (5.8%) encapsulated filtering bleb. Mean time of administering 5-FU was between the 2nd and 3rd week following surgery. Mean number of injectctions applied was 3.7 (18.5 mg 5-FU). The following complications were encountered: corneal superficial punctuate keratopathy (6 subjects), choroidal detachment (1 person), irregular astigmatism (1 person). In most cases IOP was well controlled by the end of the follow-up period (≤ 15 mmHg).

Conclusions
5-FU is safe and does not increase the perioperative risk, and has turned out to be effective in most cases of increased scarring in the filtering bleb site.