Intraocular Pressure Reduction and Complications Profile of Trabeculectomy with 5 Fluorouracil Versus Phaco-trabeculectomy with 5 Fluorouracil in Nigerian Glaucoma Patients

Abstract

Aims: To evaluate the surgical outcome of combined phacoemulsification cataract surgery plus posterior chamber intraocular and trabeculectomy with adjunctive 5-Fluorouracil versus trabeculectomy with 5-Fluorouracil in the management of Primary open angle glaucoma. Study Design: it was retrospective comparative interventional study Place and Duration of Study: Glaucoma Unit, Eye foundation Hospital Ikeja, Lagos, Nigeria between January 2015, and December 2017 Materials and Methods: A retrospective review of consecutive 29 eyes (29 patients) who had trabeculectomy with 5-Fluorouracil compared with 26 eyes (26 patients) who had combined phacotrabeculectomy with 5-Fluorouracil from 2015 to 2017. All patients had a minimum follow up of 3 months. Results: The mean age of 54.48±14.42 years in Trabeculectomy group was significantly (p>0.001) lower than 70.76±7.22 years for the Phacotrabeculectomy group.  The mean preoperative intraocular pressure (IOP) and number of glaucoma medication were similar for the two groups (19.86±9.63mmHg versus 22.23±8.99mmHg; 2.66±1.20 versus 2.73±0.72 medication, trabeculectomy versus phacotrabeculectomy respectively). The postoperative IOP and glaucoma medication after a mean follow up period of 17.11±9.81 months was not significantly different between the two groups (11.55±2.71mmHg versus 12.31±4.33mmHg, p=0.436 for trabeculectomy versus phacotrabeculectomy respectively). Both groups significantly required fewer number of antiglaucoma medication at final follow-up (1.14±0.92 vs 1.46±1.10, trabeculectomy vs phacotrabeculectomy. In the trabeculectomy group, 25 (86.2%) had IOP of ≤15mmHg with or without topical antiglaucoma drops. In the phacotrabeculectomy, 21 (80.76%) had IOP of ≤15mmHg with or without topical antiglaucoma medication (Qualified success).  On the other hand, 8 (27.58%) had IOP of ≤15mmHg without topical antiglaucoma medication at the end of the follow-up in the trabeculectomy (Complete success). In the phacotrabeculectomy group, 5 (19.23%) had final IOP of ≤15mmHg without topical antiglaucoma medication. Few complications occurred in both groups. Conclusion: Phacotrabeculectomy augmented with 5-Fluorouracil gave comparable surgical success to 5-Fluorouracil augmented trabeculectomy alone.