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The wound healing response is the single most important determinant of the final intraocular pressure (IOP) after glaucoma surgery. 1, 2 The increasing use of antimetabolites to modulate this response, particularly 5-fluorouracil (5-FU) and mitomycin C (MMC), represents one of the major new developments in glaucoma surgery over the past 15 years. However, antimetabolites have been associated with particular problems and side effects, such as hypotony, bleb leaks, and infections. 3, 4 The National Trabeculectomy Survey in the United Kingdom found that in 1996 glaucoma specialists (self reported) used intraoperative antimetabolites in only 14.7% of first time trabeculectomies for chronic open angle glaucoma (COAG). 5 This is in contrast with the United States, where a survey suggested that ophthalmologists with an interest in glaucoma used intraoperative MMC in 33% to 52% of first time trabeculectomy cases. 6
This National Survey of Antimetabolite Use is a cross sectional survey designed to assess in detail the pattern of antimetabolite use by all consultant ophthalmologists in the United Kingdom. There is a range of antifibrotic agents available, including 5-FU applied intraoperatively on a sponge, postoperative 5-FU injections, and intraoperative MMC. 7- 9 This survey investigates which of these options is preferred practice in addition to determining if antifibrotic agents are being used in first time trabeculectomy surgery as well as redo surgery.
METHODS
A postal questionnaire (see appendix) of 12 questions regarding antimetabolite use in trabeculectomy surgery was sent to all 749 consultant ophthalmologists in the United Kingdom in December 1999. They were identified according to the Royal College of Ophthalmologists database of consultants. A pilot questionnaire had previously been performed with the aid of a mixed sample of glaucoma specialists and other ophthalmologists. This was to ensure the format covered all the questions we wanted asked, was simple to answer, and the replies could be accurately interpreted. Completed questionnaires were returned to the authors in a prepaid self addressed reply envelope. Data from the paper questionnaires were entered into a customised database and analysed using Microsoft Access 2000 and SPSS (Statistical Package for Social Sciences, 1998).
RESULTS
The response rate was high, with 82% (615 out of 749) of the consultants surveyed returning the questionnaire. Data from all 615 returned questionnaires were suitable for analysis. One...