Comparison of the Outcomes of Trabeculectomy with 5-Fluorouracil versus Ologen Implant in Primary Open-Angle Glaucoma

Abstract

Purpose: To compare the outcomes of trabeculectomy with 5-fluorouracil (5-FU) versus Ologen™ implant in patients with primary open-angle glaucoma. Methods: A retrospective chart review was performed of patients with primary open-angle glaucoma who underwent trabeculectomy using either Ologen or 5-FU over 12 consecutive months. The patients had moderate-to-advanced primary open-angle glaucoma and uncontrolled intraocular pressure (IOP) on maximally tolerated medical treatment. Fornix-based trabeculectomy was performed on all patients by the same surgeon. The outcomes that were recorded and analyzed included the IOP level and number of glaucoma medications before and after surgery as well as the complications. All patients were followed for at least 3 months. Results: A total of 58 eyes (of 47 patients) were included in this study. The eyes were divided into 2 groups: the 5-FU group (n = 30, 51.7%) and the Ologen group (n = 28, 48.3%). The demographics and preoperative clinical features were not significantly different between the 2 groups. Repeated-measures analysis showed a significant decrease in IOP after trabeculectomy in both groups, with a marked decrease at day 1 after surgery. The amount of relative change at postoperative day 1 was significantly higher in the Ologen group (62.1 vs. 45.2%; p = 0.025). After this, there were no significant changes over time in IOP measurements in either group. In all the eyes, there was a significant drop in the number of antiglaucoma medications used after the surgery (p < 0.005), i.e. from 4.0 to 1.4 and from 4.3 to 1.0 in the 5-FU and Ologen groups, respectively, with no significant differences between groups (p = 0.303). Complications were few and minor in both groups. Bleb revision was needed in 2 eyes in the 5-FU group and in 4 eyes in the Ologen group. Conclusion: The efficacy and safety of trabeculectomy with 5-FU was similar to that with Ologen. Further studies with a larger number of patients and longer follow-up periods are needed.