PERIOPERATIVE WOUND LEAKS AFTER TRABECULECTOMY IN FFSS

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DESCRIPTION: (Applicant's Abstract) this application proposes further analyses of data collected in the Fluorouracil Filtering Surgery Study (FFSS). The FFSS was an NEI-sponsored, multicenter, randomized clinical trial to compare the results of trabeculectomy with and without postoperative, subconjunctival injections of 5-fluorouracil (5-FU), in patients with poor prognoses, specifically patients with previous cataract extraction or phakic patients with previously failed filtering surgery. The goals of this investigation are 1) to evaluate the risk of perioperative wound leaks (wound leaks which develop within the first two postoperative weeks after surgery) on the success rate of trabeculectomy; 2) to determine the preoperative, intraoperative, and preoperative risk factors for developing perioperative wound leaks; and 3) to document other adverse outcomes of patients with perioperative wound leaks, such as endophthalmitis, hypotony, and the development of late-onset wound leaks. The FFSS carefully scrutinized all conjunctival wounds with daily Seidel testing of all patients in both treatment groups during the first two postoperative weeks. This study thus provides a unique database to examine the question of surgical outcome and the risk factors for perioperative bleb leaks. Since antimetabolite use is becoming more common in glaucoma surgery, even among patients who have had no previous ocular surgery, insight into the risks and causes of perioperative wound leaks should be useful to guide therapy in glaucoma patients who require trabeculectomy.