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Article: Randomized Controlled Trial of Combined 5-Fluorouracil and Low-Molecular-Weight Heparin in the Management of Unselected Rhegmatogenous Retinal Detachments Undergoing Primary Vitrectomy

TitleRandomized Controlled Trial of Combined 5-Fluorouracil and Low-Molecular-Weight Heparin in the Management of Unselected Rhegmatogenous Retinal Detachments Undergoing Primary Vitrectomy
Authors
Issue Date2007
PublisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/ophtha
Citation
Ophthalmology, 2007, v. 114 n. 4, p. 698-704 How to Cite?
AbstractObjective: To determine the efficacy of a combination of 5-fluorouracil (5FU) and low-molecular-weight heparin (LMWH) in the treatment of unselected rhegmatogenous retinal detachment (RRD) undergoing primary vitrectomy. Design: Double-masked, prospective, randomized, placebo-controlled clinical trial. Participants: Six hundred forty-one patients presenting with primary RRD were recruited from 2 specialized vitreoretinal units-Moorfields Eye Hospital, London (n = 553) and St. Pauls Eye Unit, Liverpool (n = 88). Intervention: All patients underwent primary vitrectomy and gas endotamponade. Adjuvant therapy in the treatment group consisted of 5 IU/ml LMWH and 200 μg/ml 5FU added to the perioperative infusion fluid. Main Outcome Measures: The primary outcome measure was retinal reattachment after primary vitrectomy without any reoperations at 6 months. Secondary outcome measures recorded at 6 months were the occurrence and grade of proliferative vitreoretinopathy (PVR), best-corrected visual acuity in logarithm of the minimum angle of resolution, intraocular pressure (mmHg), corneal clarity, and complications. Results: The overall primary success rate was 84.4%; in the treatment group, the primary success rate was 82.3% compared with 86.8% in the placebo group (P = 0.12). At 6 months, the final complete anatomical reattachment rate was 97.9% in both treatment and placebo groups. The number of patients who failed due to the development of PVR was not statistically significant, 23 in the treatment group (7.0%) and 14 in the placebo group (4.9%) (P = 0.309). There was no significant difference in the mean visual acuity at 6 months in the placebo group (0.48) versus the treatment group (0.53; P = 0.072). The visual acuity at 6 months of patients presenting with a macula-sparing retinal detachment was significantly worse in the treatment group (P = 0.0091). There was no significant difference between the 2 groups in patients who presented with a macula involving retinal detachment (P = 0.896). Conclusions: Primary vitrectomy has a high anatomic and visual success rate for RRD. Adjuvant therapy with 5FU and LMWH does not improve the anatomic or visual success rate of unselected primary retinal detachments undergoing vitrectomy. After adjuvant therapy, a worse visual outcome was observed in patients presenting with macula-sparing retinal detachments. A combination of 5FU and LMWH should not be used routinely for primary RRD surgery. © 2007 American Academy of Ophthalmology.
Persistent Identifierhttp://hdl.handle.net/10722/90384
ISSN
2015 Impact Factor: 6.75
2015 SCImago Journal Rankings: 4.745
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorWickham, Len_HK
dc.contributor.authorBunce, Cen_HK
dc.contributor.authorWong, Den_HK
dc.contributor.authorMcGurn, Den_HK
dc.contributor.authorCharteris, DGen_HK
dc.date.accessioned2010-09-06T10:09:37Z-
dc.date.available2010-09-06T10:09:37Z-
dc.date.issued2007en_HK
dc.identifier.citationOphthalmology, 2007, v. 114 n. 4, p. 698-704en_HK
dc.identifier.issn0161-6420en_HK
dc.identifier.urihttp://hdl.handle.net/10722/90384-
dc.description.abstractObjective: To determine the efficacy of a combination of 5-fluorouracil (5FU) and low-molecular-weight heparin (LMWH) in the treatment of unselected rhegmatogenous retinal detachment (RRD) undergoing primary vitrectomy. Design: Double-masked, prospective, randomized, placebo-controlled clinical trial. Participants: Six hundred forty-one patients presenting with primary RRD were recruited from 2 specialized vitreoretinal units-Moorfields Eye Hospital, London (n = 553) and St. Pauls Eye Unit, Liverpool (n = 88). Intervention: All patients underwent primary vitrectomy and gas endotamponade. Adjuvant therapy in the treatment group consisted of 5 IU/ml LMWH and 200 μg/ml 5FU added to the perioperative infusion fluid. Main Outcome Measures: The primary outcome measure was retinal reattachment after primary vitrectomy without any reoperations at 6 months. Secondary outcome measures recorded at 6 months were the occurrence and grade of proliferative vitreoretinopathy (PVR), best-corrected visual acuity in logarithm of the minimum angle of resolution, intraocular pressure (mmHg), corneal clarity, and complications. Results: The overall primary success rate was 84.4%; in the treatment group, the primary success rate was 82.3% compared with 86.8% in the placebo group (P = 0.12). At 6 months, the final complete anatomical reattachment rate was 97.9% in both treatment and placebo groups. The number of patients who failed due to the development of PVR was not statistically significant, 23 in the treatment group (7.0%) and 14 in the placebo group (4.9%) (P = 0.309). There was no significant difference in the mean visual acuity at 6 months in the placebo group (0.48) versus the treatment group (0.53; P = 0.072). The visual acuity at 6 months of patients presenting with a macula-sparing retinal detachment was significantly worse in the treatment group (P = 0.0091). There was no significant difference between the 2 groups in patients who presented with a macula involving retinal detachment (P = 0.896). Conclusions: Primary vitrectomy has a high anatomic and visual success rate for RRD. Adjuvant therapy with 5FU and LMWH does not improve the anatomic or visual success rate of unselected primary retinal detachments undergoing vitrectomy. After adjuvant therapy, a worse visual outcome was observed in patients presenting with macula-sparing retinal detachments. A combination of 5FU and LMWH should not be used routinely for primary RRD surgery. © 2007 American Academy of Ophthalmology.en_HK
dc.languageengen_HK
dc.publisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/ophthaen_HK
dc.relation.ispartofOphthalmologyen_HK
dc.rightsNOTICE: this is the author’s version of a work that was accepted for publication in <Journal title>. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in PUBLICATION, [VOL#, ISSUE#, (DATE)] DOI#en_HK
dc.subject.meshCombined Modality Therapy-
dc.subject.meshDalteparin - therapeutic use-
dc.subject.meshFluorouracil - therapeutic use-
dc.subject.meshRetinal Detachment - drug therapy - surgery-
dc.subject.meshVitrectomy-
dc.titleRandomized Controlled Trial of Combined 5-Fluorouracil and Low-Molecular-Weight Heparin in the Management of Unselected Rhegmatogenous Retinal Detachments Undergoing Primary Vitrectomyen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0161-6420&volume=114&issue=4&spage=698&epage=704&date=2007&atitle=Randomized+controlled+trial+of+combined+5-Fluorouracil+and+low-molecular-weight+heparin+in+the+management+of+unselected+rhegmatogenous+retinal+detachments+undergoing+primary+vitrectomyen_HK
dc.identifier.emailWong, D: shdwong@hku.hken_HK
dc.identifier.authorityWong, D=rp00516en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.ophtha.2006.08.042en_HK
dc.identifier.pmid17398320-
dc.identifier.scopuseid_2-s2.0-33947595650en_HK
dc.identifier.hkuros136211en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-33947595650&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume114en_HK
dc.identifier.issue4en_HK
dc.identifier.spage698en_HK
dc.identifier.epage704en_HK
dc.identifier.eissn1549-4713-
dc.identifier.isiWOS:000245440400014-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridWickham, L=15520285500en_HK
dc.identifier.scopusauthoridBunce, C=7005268305en_HK
dc.identifier.scopusauthoridWong, D=7401536078en_HK
dc.identifier.scopusauthoridMcGurn, D=16067204000en_HK
dc.identifier.scopusauthoridCharteris, DG=7003299563en_HK

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