{"id":709,"date":"2010-12-08T13:02:51","date_gmt":"2010-12-08T18:02:51","guid":{"rendered":"http:\/\/www.bu.edu\/?page_id=709"},"modified":"2010-12-08T13:08:35","modified_gmt":"2010-12-08T18:08:35","slug":"fluorouracil-filtering-surgery-study-ffss","status":"publish","type":"page","link":"https:\/\/www.bu.edu\/eye\/evidence-based-medicine\/glaucoma-studies\/fluorouracil-filtering-surgery-study-ffss\/","title":{"rendered":"Fluorouracil Filtering Surgery Study (FFSS)"},"content":{"rendered":"

Fluorouracil Filtering Surgery Study (FFSS)<\/span><\/strong><\/p>\n

PURPOSE:<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 To determine if subconjunctival injections of 5-fluorouracil (5-FU) given postop after glaucoma filtering surgery boost the success rate in patients at high risk for failure<\/p>\n

STUDY DESIGN:<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Randomized, controlled clinical trial<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 213 patients enrolled- 162 aphakic, 51 with history of filtering surgery- all with IOP greater than 21 mm Hg on maximal tolerated therapy<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Evaluated success of standard glaucoma filtering vs standard surgery with adjunctive 5-FU injections<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Adverse ocular and systemic effects of 5-FU injections assessed in terms of frequency and severity and were monitored for treatment complications<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Postoperatively randomized to standard care or 5-FU injections<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 For 5-FU group, 5 mg of 5-FU injected twice daily on 1st<\/sup> to 7th<\/sup> postop days and daily on 8th<\/sup> to 14th<\/sup> postop days<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Standard postop follow up for 5 years<\/p>\n

RESULTS:<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Success = no need for additional surgery to control IOP; no recorded IOP > 21 at\/after 1-year follow-up<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 5-FU led to improved IOP control\/success rates during all follow-up periods (48 % for 5-FU vs 21% for standard group at 5 years)<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Patients noted to have decreased loss of VA loss if IOP remained controlled compared to uncontrolled IOP<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 No difference in change in VF sensitivity between two groups<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Visual field loss related to high IOP- patients requiring repeat operation showed more VF loss<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 VA and VF loss observed in both groups during the 5 years of the study<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Factors associated with success rate include preop IOP, number of conjunctival incisions during previous ocular procedures, and the time period between the study filtering surgery and previous intraocular surgery<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 5-FU group with higher rate of late-onset filtering bleb leak (9 percent vs 2 percent) and more cases of endophthalmitis (2 cases vs 1 case).<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 No other long-term adverse effects were significantly different between two groups<\/p>\n

TEACHING POINTS:<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 5-FU injections recommended after trab in aphakic patients or in patients with a history of unsuccessful filtering surgery given lower success rates<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Proved relationship between high preop IOP and acute postop hypotony as risk for suprachoroidal hemorrhage. Measures now in place to prevent postop hypotony if high IOP noted preop with multiple tightly tied sutures or with releasable sutures in the scleral flap to have additional control on postop IOP.<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Given possibility of complications related to 5-FU, caution use in patients with higher success rates with filtering surgery<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 IOP control is essential to preserving visual function<\/p>\n","protected":false},"excerpt":{"rendered":"

Fluorouracil Filtering Surgery Study (FFSS) PURPOSE: –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 To determine if subconjunctival injections of 5-fluorouracil (5-FU) given postop after glaucoma filtering surgery boost the success rate in patients at high risk for failure STUDY DESIGN: –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Randomized, controlled clinical trial –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 213 patients enrolled- 162 aphakic, 51 with history of filtering surgery- all with IOP greater […]<\/p>\n","protected":false},"author":1980,"featured_media":0,"parent":700,"menu_order":5,"comment_status":"closed","ping_status":"open","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/www.bu.edu\/eye\/wp-json\/wp\/v2\/pages\/709"}],"collection":[{"href":"https:\/\/www.bu.edu\/eye\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.bu.edu\/eye\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/eye\/wp-json\/wp\/v2\/users\/1980"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/eye\/wp-json\/wp\/v2\/comments?post=709"}],"version-history":[{"count":3,"href":"https:\/\/www.bu.edu\/eye\/wp-json\/wp\/v2\/pages\/709\/revisions"}],"predecessor-version":[{"id":805,"href":"https:\/\/www.bu.edu\/eye\/wp-json\/wp\/v2\/pages\/709\/revisions\/805"}],"up":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/eye\/wp-json\/wp\/v2\/pages\/700"}],"wp:attachment":[{"href":"https:\/\/www.bu.edu\/eye\/wp-json\/wp\/v2\/media?parent=709"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}