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Use of subconjunctival injections of 5-fluorouracil to rescue and prolong intraocular pressure reduction for a failing Ahmed glaucoma implant

  • Glaucoma
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

5-Fluorouracil (5-FU) has been well described for a failing trabeculectomy bleb, but not for aqueous shunts. We sought to determine whether subconjunctival 5-FU prolongs the intraocular pressure (IOP) efficacy of Ahmed shunts.

Methods

We included all patients with Ahmed FP-7 implantation by one surgeon at Yale University. Patients with <3 months follow-up were excluded. Injections were done on a case-by-case basis, usually for IOP > 21 on >2 medications. Five-milligram (0.1 cc) injections were made over the plate. The control group consisted of Ahmed FP-7 patients without injections. The main outcome measure was IOP. Secondary outcome was success (IOP <21 mmHg, 20% decrease from preoperative IOP, and no reoperation).

Results

The average age of controls was 72.5 ± 16.6 years, and 63.7 ± 18.8 with 5-FU (p = 0.02). Forty-four patients received 5-FU and 45 did not. Mean preoperative IOP in controls was 31.5 ± 11 mmHg on 3.1 ± 1 medications, and 31.9 ± 9.0 mmHg (p = 0.86) on 3.3 ± 0.9 medications with 5-FU (p = 0.18). At a mean 137 days after surgery, mean pre-injection IOP was 25.3 ± 7.7 mmHg on 2.0 ± 1.3 medications. Five years following implantation, control IOPs averaged 12.9 ± 7.1 mmHg (53% decrease from preoperative IOP, p < 0.001) on 1.4 ± 1.1 medications versus 17.2 ± 4.9 mmHg (46% decrease from preoperative, 32% decrease from pre-5FU IOP, p < 0.001) on 2.7 ± 0.8 medications with 5-FU. The IOP at 5 years was statistically similar in both groups (p = 0.23). Five-year success rates trended higher with 5-FU (77 vs. 67%, p = 0.38).

Conclusions

Subconjunctival injection of 5-FU sustained a significant long-term decline in intraocular pressures in eyes with failing Ahmed shunts. Outcomes between eyes receiving injections and controls were statistically similar.

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Authors and Affiliations

  1. Loma Linda VA, Loma Linda University, 11201 Benton St, Loma, Linda, CA, 92357, USA

    Kevin Kaplowitz

  2. Center for Advanced Eye Care, 3500 U.S. 1, Vero Beach, FL, 32968, USA

    Sarah Khodadadeh

  3. Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA

    Samantha Wang

  4. Wills Eye Hospital, 840 Walnut Street Suite 1110, Philadelphia, PA, 19107, USA

    Daniel Lee

  5. Icahn School of Medicine at Mount Sinai, New York Eye and Ear Infirmary of Mount Sinai, 310 East 14th Street, New York, NY, 10003, USA

    James C. Tsai

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  1. Kevin Kaplowitz
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  2. Sarah Khodadadeh
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  3. Samantha Wang
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  4. Daniel Lee
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  5. James C. Tsai
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Corresponding author

Correspondence to James C. Tsai.

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Funding/support

Supported in part by an unrestricted departmental grant from Research to Prevent Blindness, Inc., New York, NY (JCT). The sponsor had no role in the design or conduct of this research.

Financial disclosures

All authors report no proprietary or commercial interest in any product or concept discussed here.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki Declaration and its later amendments. As this was a retrospective study, the IRB did not require formal consent.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria, educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

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Kaplowitz, K., Khodadadeh, S., Wang, S. et al. Use of subconjunctival injections of 5-fluorouracil to rescue and prolong intraocular pressure reduction for a failing Ahmed glaucoma implant. Graefes Arch Clin Exp Ophthalmol 255, 1185–1191 (2017). https://doi.org/10.1007/s00417-017-3649-2

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  • DOI: https://doi.org/10.1007/s00417-017-3649-2

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