Changes in macular thickness after trabeculectomy with or without adjunctive 5-fluorouracil

Aistė Kadziauskienė, Ernesta Strelkauskaitė, Eglė Mockevičiūtė, Rimvydas Ašoklis, Eugenijus Lesinskas, Leopold Schmetterer, Aistė Kadziauskienė, Ernesta Strelkauskaitė, Eglė Mockevičiūtė, Rimvydas Ašoklis, Eugenijus Lesinskas, Leopold Schmetterer

Abstract

Conflict of interest: None of the authors have any conflict of interest to declare, financial or otherwise. No financial or other support was received for the study.

Background: The aim of the study was to assess changes in macular thickness after trabeculectomy in respect to the use of 5-fluorouracil (5-FU) as well as to analyse possible associations between the postoperative changes in macular thickness and intraocular pressure (IOP).

Materials and methods: The prospective observational study included 106 eyes (100 patients) with glaucoma who underwent trabeculectomy with or without 5-FU. Subsequently 5-FU needling was performed if failure of the filtrating bleb occurred. Macular thickness and the IOP were evaluated before, one week, and six months after the surgery. The mean and sectoral macular thickness was assessed using spectral domain optical coherence tomography.

Results: The mean (±SD) IOP reduced from 27.71 (±6.88) mmHg at baseline to 18.3 (±8.1) mmHg one week (p < 0.001) and 15.1 (±7.6) mmHg six months (p < 0.001) after trabeculectomy. One week postoperatively, the mean macular thickness increased from 285.19 (±15.98) μm to 288.9 (±16.31) μm (p < 0.001); macular thickening was significant in all subfields (p < 0.001) and correlated positively with IOP reduction (rho = 0.312, p = 0.001 for central subfield). After six months, macula remained thicker only at the central and inner nasal subfields (p < 0.05). The changes in macular thickness were not affected by the use of 5-fluorouracil.

Conclusions: Trabeculectomy may induce a slight macular thickening which is more pronounced in the early postoperative period. The IOP reduction plays an important role in this process and is associated with thicker postoperative macula. However, the use of adjunctive 5-FU has no influence on macular thickness after glaucoma surgery despite its potential hypotonic, inflammatory and cytotoxic effects.

Keywords: 5-fluoruracil; intraocular pressure; macula; retinal thickness; trabeculectomy.

Figures

Fig. 1.
Fig. 1.
Measurements of macular thickness with spectral domain optical coherence tomography Macular thickness was measured using enhanced depth imaging optical coherence tomography at 9 subfields (a): CM, central macula ; SIM, superior inner macula, TIM, temporal inner macula, IIM, inferior inner macula; NIM, nasal inner macula SOM, superior outer macula; TOM, temporal outer macula; IOM, inferior outer macula, NOM, nasal outer macula. The retinal thickness was defined as distance between hyperreflective internal limiting membrane (ILM) and Bruch’s membrane (BM) (b).
Fig. 2.
Fig. 2.
Correlation between the macular thickening and IOP reduction one week after trabeculectomy A positive correlation between magnitude of change in mean, central, proximal temporal and proximal nasal macular thickness and IOP reduction (rho = 0.352, p < 0.001; rho = 0.312, p = 0.001; rho = 0.346, p = 0.001 and rho = 0.352, p < 0.001, respectively.

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