http://www.evrs.eu/medias/2006/congress/Effect-of-Intraoperative-5-Fluorouracil-and-Low-Molecular-Weight-Heparin-on-the-Outcome-in-High-risk-Proliferative-Vitreoretinopathy.swf

Guruprasad S. Ayachit, MS (Hubli, Karnataka, India), Paul Tornambe, MD (Poway, CA)

PURPOSE:

To determine whether these pharmacological agents prevent PVR. To determine whether there are any adverse effects.

METHODS:

In this prospective randomized single masked controlled study the cases were randomized into two groups of matching grades of PVR. In Group I (study) 20 patients underwent surgery for PVR with the use of intraoperative 5-FU 0.2 mg/ml and LMWH 5 units/ml i. e 5-FU 100mg and LMWH 2500 units in 500ml infusate bottle and in Group II (control) 20 patients underwent similar surgery without 5 FU and LMWH. Basic surgical steps were the same for both the groups. The same surgeon performed all the 40 surgeries. Outcomemeasures considered were retinal reattachment with single operation at the end of 3 months, visual recovery, recurrence of PVR.

RESULTS:

Both the groups were matching in etiological factors causing the detachment and predictive scores for postoperative PVR, the average scores being 8.68 in Group-I and 9.13 in Group-II. Retinal reattachment with single operation at the end of 3rd month was found in 13(65%) in Group-I and 12 (60%) in Group-II. Chi-square test x2 ??0.106, p > 0.05 (i.e. considering 95% confidence interval) statistically not a significant difference. Vision of finger counting > 1′ < 3′ was seen in 3(15%) of Group-I and 1 (5%) of Group-II patients. Vision of > 1/60 was seen in 7 (35%) of Group-I¬† and 8 (40%) of Group-II patients. ( Chi-square test x2 ? 0.1002 , p>0.05 statistically not significant). Recurrence of PVR was seen in total 9 (45%) in Group-I and 11 (55%) in Group-II patients. ( Chi-square test x2 ??0.40, p > 0.05 statistically not significant). No treatment related toxicity was observed except for intraoperative bleeding in 1 (5%)¬†patient in Group-I.

CONCLUSION:

In conclusion our study fails to prove the efficacy of intraoperative use of antiproliferative drug treatment in prevention of postoperative proliferative vitreo retinopathy. However as shown by previous literature these antiproliferative drugs are found to be effective in prevention of postoperative proliferation and negative results of a single clinical study should be viewed with caution.