Combined phacoemulsification and trabeculectomy with mitomycin and postoperative 5-fluorouracil (5-FU)
Purpose: To determine the effectiveness of using a combination of antimetabolites in combined cataract extraction and trabeculectomy as measured by intraocular pressure (IOP) reduction and elimination of glaucoma medications. Methods: We reviewed all combined cataract extraction and trabeculectomy surgeries with mitomycin and postoperative 5-FU (n=60) performed between May 1993 and August 1995. Mitomycin 0.3 mg/ml was applied intraoperatively for 3 minutes. Postoperative 5-FU was given in 2.5 mg/0.1 ml doses in the superior quadrant during the first 2 weeks postoperatively. IOP was compared to preoperative IOP at 3, 6,12 months, and final IOP. Postoperative medication use was compared to preoperative use. Results: Postoperative IOP was significantly lower than preoperative IOP at all measured intervals. Postoperative medication use was significantly lower than preoperative medication use. Postoperative complications secondary to hypotony consisted of 2 cases of persistent choroidal effusion that required drainage and 2 cases of suprachoroidal hemorrhage; 1 intraoperative requiring postoperative drainage, and 1 postoperative which resolved spontaneously. Conclusions: Combined cataract extraction and trabeculectomy using a combination of intraoperative mitomycin and postoperative 5-FU appear to lower postoperative IOP and reduce the need for postoperative medication use.