Injections of 5-Fluorouracil compared to placebo after surgery for glaucoma

Wormald R, Wilkins M, Bunce C

Published Online:

January 21, 2009

Glaucoma involves a loss of vision which may be associated with raised pressure inside the eye. When glaucoma is diagnosed, it is common to try to reduce that pressure with medical, laser or surgical interventions (trabeculectomy). Surgery does not immediately restore vision, and may involve extra vision loss in the short term. Drugs can be used to modify wound healing to improve the likelihood of the success of surgery. The review of the effects of one of those drugs, 5-Fluorouracil, found that injections after surgery improved outcomes for people at high risk of problems. However for others, the risk of serious complications may not be worthwhile.

Abstract (click to read)

Background:

Trabeculectomy is performed as a treatment for many types of glaucoma in an attempt to lower the intraocular pressure. The surgery involves creating a channel through the sclera, through which intraocular fluid can leave the eye. If scar tissue blocks the exit of the surgically created channel intraocular pressure rises and the operation fails. Antimetabolites such as 5-Fluorouracil (5-FU) are used to inhibit wound healing to prevent the conjunctiva scarring down on to the sclera.

Objectives:

To assess the effects of postoperative injections of 5-FU in eyes of people undergoing surgery for glaucoma.

Search strategy:

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4, 2008), MEDLINE (January 1966 to October 2008) and EMBASE (January 1980 to October 2008), the reference lists of relevant articles and the Science Citation Index. We contacted investigators and experts for details of additional relevant trials. There were no language or date restrictions in the search for trials. The electronic databases were last searched on 29 October 2008.

Selection criteria:

We included randomised trials of postoperative 5-FU injections compared to placebo injections or no injections in trabeculectomy for glaucoma.

Data collection and analysis:

Two authors independently assessed trial quality and extracted data. We contacted trial investigators for missing information. Data were summarised using risk ratio, Peto odds ratio and mean difference as appropriate.

Main results:

Nine trials, which randomised a total of 614 participants, were included in the review. As far as can be determined from the trial reports the methodological quality of the trials was not high. When delivered by postoperative injection, 5-FU appears to be effective in reducing the likelihood of surgical failure of trabeculectomy both in eyes at high risk of failure and those undergoing surgery for the first time. The results suggest that injection of low doses of 5-FU may not be effective. Whilst no evidence was found of an increased risk of serious sight threatening complications, other complications are more common after 5-FU injections. None of the trials reported on the participants' perspective of care.

Authors' conclusions:

Postoperative injections of 5-FU are now rarely used as a planned series but are increasingly used on an ad hoc basis. This presumably reflects an aspect of the treatment that is unacceptable to both patients and doctors. None of the trials reported on the participants' perspective of care which constitutes a serious omission for an invasive treatment such as this.

This record should be cited as:

Wormald R, Wilkins M, Bunce C. Postoperative 5-Fluorouracil for glaucoma surgery. Cochrane Database of Systematic Reviews 2001, Issue 3. Art. No.: CD001132. DOI: 10.1002/14651858.CD001132

Assessed as up to date:

October 29, 2008

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Primary Review Group:

Eyes and Vision Group

Health topics:

Eyes & vision > Glaucoma > Open angle

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Injections of 5-Fluorouracil compared to placebo after surgery for glaucoma

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