EVALUATING THE EFFICACY OF MITOMYCIN C VERSUS 5-FLUOROURACIL IN TRABECULECTOMY FOR INTRAOCULAR PRESSURE CONTROL IN MEDICALLY UNCONTROLLED PRIMARY OPEN-ANGLE GLAUCOMA

Background: Primary open-angle glaucoma(POAG) is one of the leading causes of blindness, and intraocular pressure (IOP) is the most important modifiable risk factor. Trabeculectomy is a standard surgical method used to control IOP, typically administered with concomitant application of anti-fibrotic agents such as Mitomycin C (MMC) and 5-Fluorouracil (5-FU) in an attempt to curb scarring, a complication that can lead to poor outcomes. Objectives: To compare the effectiveness and safety of MMC with 5-FU as adjuncts in trabeculectomy for IOP control in medically uncontrolled POAG,assessing safety and long-term outcomes. Study design: A prospective study. Place and Duration of study: Department of Ophthalmology, Gaju Khan Medical College, Sawabi. The study was carried out over one year, from January 2024 to June 2024. Methods: One hundred patients with medically uncontrolled POAG undergoing trabeculectomy were randomly assigned, with half receiving MMC and the other half 5-FU. The primary outcome was IOP at standard time frames following surgery. Secondary outcomes included IOP control and complication rates. Data were analyzed using SPSS 24.0. Results: The mean age was 62.3± 7.1 years in the MMC group and 61.8 ± 6.9 years in the 5-FU group. Both groups had comparable baseline IOP (MMC: 28.4 ± 4.2 mmHg; 5-FU: 29.1 ± 4.5 mmHg; p = 0.23). At 12 months, the mean IOP was significantly lower in the MMC group (14.2 ± 3.1 mmHg) compared to the 5-FU group (16.5 ± 4.0 mmHg; p < 0.05). The MMC group showed a greater success rate (86%) versus the 5-FU group (72%) (p < 0.05). Conclusion: In cases of medically uncontrolled primary open-angle glaucoma(POAG), trabeculectomy with mitomycin-C (MMC) achieves greater intraocular pressure (IOP) reduction compared to 5-fluorouracil (5-FU). Therefore, informed and confident clinical decision-making is essential for effective disease management.