Long-term Comparison of Primary Trabeculectomy With 5-Fluorouracil Versus Mitomycin C in West Africa

Purpose: To compare the long-term efficacy and safety of intraoperative 5-fluorouracil (5-FU) versus mitomycin-C (MMC) used adjunctively with primary trabeculectomy in a Black West African population. Design: Retrospective comparative study supplemented with cross-sectional follow-up data. Methods: Review of 68 eyes of 68 Black West African subjects that underwent primary trabeculectomy with the use of intraoperative 5-FU or MMC between January 1, 1988 and January 1, 2002 and had at least 3 years postoperative follow-up. Postoperative outcome measures included intraocular pressure (IOP) control, number of glaucoma medications, visual acuity and complications. Results: Thirty-eight of sixty-eight eyes received 5-FU and 30 received MMC. Mean Postoperative follow-up was 7.5 and 6.5 years in the 5-FU and MMC groups, respectively (P = 0.17) A higher proportion of eyes in the MMC group achieved qualified (with or without medical therapy) success with varying IOP targets relative to the 5-FU group, but the differences were not statistically significant. Complete (without medical therapy) postoperative success was greater in the MMC group with a significantly higher proportion achieving an IOP < 21 mm Hg (P = 0.02). MMC use was also associated with a lower likelihood of receiving IOP-lowering medications postoperatively (P = 0.01). Baseline demographic characteristics, preoperative and postoperative IOP, visual acuity, and complications did not differ significantly between the 2 groups. Conclusions: Intraoperative MMC use is associated with a lower likelihood of requiring postoperative medications and a greater likelihood of achieving IOP lowering without medications relative to the use of 5-FU in a Black West African population.