Özlem DİKMETAŞ, Sepideh LOTFISADIGH, Ali Bülent ÇANKAYA, Sibel KOCABEYOĞLU, Merve KAŞIKÇI

The Results of Trabeculectomy with Antimetabolites in Elderly Patients: A Retrospective Study

Objective: To examine the effectiveness and results of primary trabeculectomy with 5-fluorouracil (group 1) or mitomycin-C (group 2) in elderly patients. Materials and Methods: This was a retrospective study including 67 eyes with primary open-angle glaucoma that underwent primary trabeculectomy with group 1 or group 2. Patients who were followed up for less than 1 year or were under 55 years of age were excluded from the study. Surgical success was evaluated according to a decrease in cup/disk ratio and reduction of intraocular pressure without any topical medication. Results: The mean ages of participants were 65.7 years (range 59–88) and 65.9 years (range 59–74) in groups 1 and 2, respectively. The mean preoperative and postoperative intraocular pressure values were 31.3 ± 5.7 mmHg (range 17–46) and 14.8 ± 0.4 mmHg (range 10–21) in group 1 (p < 0.001) and 31.5 ± 7.4 mmHg (range 18–52) and 14.8 ± 2.9 mmHg (range 10–21) in group 2 (p < 0.001). Conclusion: The use of 5-fluorouracil or mitomycin-C during primary trabeculectomy is associated with high postoperative success rates. There were no significant differences between 5-fluorouracil and mitomycin-C in terms of intraocular pressure reduction.

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[1] Quigley HA. 21st century glaucoma care. Eye (Lond). 2019; 33(2): 254-260. (PMID: 30305707).

[2] Duman F, Waisbourd M, Faria B, et al. Trabeculectomy in Patients With Glaucoma Over 80 Years of Age: Relatively Short-term Outcomes. J Glaucoma. 2016; 25(3): 123-127. (PMID: 25715005).

[3] Popescu ML, Boisjoly H, Schmaltz H, et al. Explaining the relationship between three eye diseases and depressive symptoms in older adults. Invest Ophthalmol Vis Sci. 2012; 53(4): 2308-2313. (PMID: 22427589).

[4] Cairns JE. Trabeculectomy. Preliminary report of a new method. Am J Ophthalmol. 1968; 66(4): 673-679. (PMID: 4891876).

[5] Watson PG, Barnett F. Effectiveness of trabeculectomy in glaucoma. Am J Ophthalmol. 1975; 79(5): 831-845. (PMID: 1146946).

[6] Al-Haddad CE, Abdulaal M, Al-Moujahed A, et al. FornixBased Versus Limbal-Based Conjunctival Trabeculectomy Flaps for Glaucoma: Findings From a Cochrane Systematic Review. Am J Ophthalmol. 2017; 174(1): 33-41. (PMID: 27794426).

[7] Gressel MG, Parrish RK, Folberg R. 5-fluorouracil and glaucoma filtering surgery: I. An animal model. Ophthalmology. 1984; 91(4): 378-383. (PMID: 6717922).

[8] Heuer DK, Parrish RK, Gressel MG, et al. 5-fluorouracil and glaucoma filtering surgery. II. A pilot study. Ophthalmology. 1984; 91(4): 384-394. (PMID: 6201793).

[9] Palmer SS. Mitomycin as adjunct chemotherapy with trabeculectomy. Ophthalmology. 1991; 98(3): 317-321. (PMID: 2023752).

[10] Three-year follow-up of the Fluorouracil Filtering Surgery Study. Am J Ophthalmol. 1993; 115(1): 82-92. (PMID: 8420383).

[11] Five-year follow-up of the Fluorouracil Filtering Surgery Study. The Fluorouracil Filtering Surgery Study Group. Am J Ophthalmol. 1996; 121(4): 349-366. (PMID: 8604728).

[12] Wilkins M, Indar A, Wormald R. Intra-operative mitomycin C for glaucoma surgery. Cochrane Database Syst Rev. 2005; 19(4): 002897. (PMID: 16235305).

[13] Vinod K, Gedde SJ, Feuer WJ, et al. Practice Preferences for Glaucoma Surgery: A Survey of the American Glaucoma Society. J Glaucoma. 2017; 26(8): 687-693. (PMID: 28692597).

[14] Kuroda U, Inoue T, Awai-Kasaoka N, et al. Fornix-based versus limbal-based conjunctival flaps in trabeculectomy with mitomycin C in high-risk patients. Clin Ophthalmol. 2014; 15(8): 949-954. (PMID: 24868145).

[15] Takihara Y, Inatani M, Fukushima M, et al. Trabeculectomy with mitomycin C for neovascular glaucoma: prognostic factors for surgical failure. Am J Ophthalmol. 2009; 147(5): 912-918. (PMID: 19195639).

[16] Fluorouracil Filtering Surgery Study G. Fluorouracil Filtering Surgery Study One-Year Follow-up. Am J Ophthalmol. 2018; 186(2): 33-35. (PMID: 29420951).

[17] Ohnell H, Heijl A, Brenner L, et al. Structural and Functional Progression in the Early Manifest Glaucoma Trial. Ophthalmology. 2016; 123(6): 1173-1180. (PMID: 26949119)

[18] Leske MC, Heijl A, Hyman L, et al. Factors for progression and glaucoma treatment: the Early Manifest Glaucoma Trial. Curr Opin Ophthalmol. 2004; 15(2): 102-106. (PMID: 15021220).

[19] Leske MC, Heijl A, Hussein M, Bengtsson B, et al. Factors for glaucoma progression and the effect of treatment: the early manifest glaucoma trial. Arch Ophthalmol. 2003; 121(1): 48-56. (PMID: 12523884).

[20] Junoy Montolio FG, Muskens R, Jansonius NM. Influence of glaucoma surgery on visual function: a clinical cohort study and meta-analysis. Acta Ophthalmol. 2019; 97(2): 193-199. (PMID: 30288923).

[21] Singh K, Mehta K, Shaikh NM, et al. Trabeculectomy with intraoperative mitomycin C versus 5-fluorouracil. Prospective randomized clinical trial. Ophthalmology. 2000; 107(12): 2305-2309. (PMID: 11097613).

[22] Stone RT, Herndon LW, Allingham RR, et al. Results of trabeculectomy with 0.3 mg/ml mitomycin C titrating exposure times based on risk factors for failure. J Glaucoma. 1998; 7(1): 39-44. (PMID: 9493114).

[23] Carlson DW, Alward WL, Barad JP, et al. A randomized study of mitomycin augmentation in combined phacoemulsification and trabeculectomy. Ophthalmology. 1997; 104(4): 719-724. (PMID: 9111269).

[24] Goldenfeld M, Krupin T, Ruderman JM, et al. 5-Fluorouracil in initial trabeculectomy. A prospective, randomized, multicenter study. Ophthalmology. 1994; 101(6): 1024- 1029. (PMID: 8008342).

[25] Cankaya AB, Elgin U. Comparison of the outcome of repeat trabeculectomy with adjunctive mitomycin C and initial trabeculectomy. Korean J Ophthalmol. 2011; 25 (6): 401- 408. (PMID: 22131777).