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Purpose: To test the effect of postoperative subconjunctival 5-fluorouracil (5-FU) on the pressure outcome in combined procedure (limbus-based trabeculectomy + clearcornea phacoemulsification). Methods: Prospective randomized, controlled clinical trial; n=24 eyes (24 patients) with concurrent open-angle glaucoma and cataract; 12 eyes per treatment group; sample size adjusted for a minimal expected difference in the event rate between the 2 treatment groups=50%, control rate=20%; type I error=0.05; power=95%. Uncomplicated limbus-based trabeculectomy + uncomplicated clear-cornea phacoemulsification + posterior chamber intraocular lens. The 5-FU group=five subconjunctival injections of 5 mg 5-FU, starting from day 8 after surgery, one injection per week. Control group=no injections. The groups were matched for age, preoperative intraocular pressure (IOP), duration of preoperative antiglaucoma treatment, preoperative pilocarpine and adrenergics, preoperative laser trabeculoplasty, and β-blockers in the fellow eye. The IOP less than or equal to 15 mmHg without treatment 1 year after surgery (IOP = average of the two highest values measured in the diurnal curve, 8 AM to 6 PM, one reading every 2 hours). Results: Each patient completed a 1-year follow-up. Ten of 12 eyes of the 5-FU group showed an IOP less than or equal to 15 mmHg at the end of follow-up versus 1 of 12 eyes in the control group (Fisher's exact test, P=0.00064). The IOP range was 10 to 17 mmHg in the 5-FU group and 14 to 22 mmHg in the control group. Conclusion: Postoperative 5-FU may improve the 1-year success rate of trabeculectomy combined with clear-cornea phacoemulsification.

Purpose: To determine whether an iridotomy can prevent an increase in intraocular pressure (IOP) in patients with pigment dispersion syndrome. Methods: Consecutive subjects (n = 21) recruited into this randomized, controlled clinical trial in a hospital-based outpatient referral center, had pigment dispersion syndrome in both eyes, and underwent a YAG laser iridotomy in one eye randomly chosen); no intervention was performed in the fellow eye. A significant elevation of IOP was arbitrarily defined as an increase of more than 5 mmHg. Results: Eleven (52.3%) untreated eyes versus 1 (4.7%) treated eye showed a significant elevation of IOP during the 2-year follow-up. The IOP difference between the untreated and the fellow treated eye at the end of the 2-year follow-up period is inversely related to the age of each patient. Conclusion: YAG laser iridotomy may reduce the incidence of ocular hypertension in eyes affected by pigment dispersion syndrome. This effect, being less pronounced after 40 years of age, may be of clinical relevance in young subjects.