Australia and New Zealand Survey of Antimetabolite and Steroid Use in Trabeculectomy Surgery

AIM: To assess the pattern of use of antimetabolites and steroids in trabeculectomy surgery among consultant ophthalmologists in Australia and New Zealand. METHOD: A postal questionnaire of 25 questions regarding current glaucoma practices and antimetabolite and steroid use in trabeculectomy surgery was sent to all practicing Australian and New Zealand Fellows of the Royal Australia and New Zealand College of Ophthalmologists in July 2005. The second half of the survey consisted of questions on the number of trabeculectomies performed per year, topical steroid use, the type of antimetabolite used, and assessment of factors that may influence the decision to use them. The results were cross-tabulated according to state/country, years practicing, type of practice, and being a glaucoma subspecialist (GSS). RESULTS: The overall response rate was 78% (627 out of 808). Ninety-one percent stated that they managed glaucoma of which 65% stated that they perform trabeculectomy surgery and 16% considered themselves as a GSS. In 2004, 75% of ophthalmologists performed less than 10 trabeculectomies. Sixty-one percent used an antimetabolite in trabeculectomy surgery of which 5-fluorouracil was used 51% (intraoperatively) and 24% (postoperatively). Mitomycin C was used in 12% and 0.2 mg/mL was the most commonly used concentration for 2 or 3 minutes. Fifty-four percent used postoperative steroids in a primary trabeculectomy for 1 to 2 months with 48% of GSSs using it for 2 to 3 months. Forty-eight percent to 96% would use an antimetabolite in patients with risk factors for conjunctival scarring. CONCLUSIONS: This survey shows a wide range of the use of antimetabolites and steroids in trabeculectomy surgery with 5-fluorouracil being most commonly used. GSSs and young ophthalmologists would use antimetabolites more often and postoperative steroids for longer. This survey allows ophthalmologists to compare their own practices with those of their colleagues in Australia and the United Kingdom.