Évaluation clinique de 5FU-héparine dans la prévention de la prolifération vitréorétinienne

Purpose: To study the safety and efficacy of adjuvant combination therapy using 5-fluorouracil and heparin for prevention of proliferative vitreoretinopathy (PVR) during vitrectomy for retinal detachment surgery. Methods: Two consecutive groups of 30 eyes with a rhegmatogenous retinal detachment (grade C1 or more) were prospectively compared. In the study group, 5-FU and heparin were administrated in the intraoperative infusion. Clinical safety and the efficacy were regularly studied over 1 year. Results: In the 5-FU heparin therapy group, keratitis was more frequently observed the 1st day after surgery (p=0.005), but not after 1 week (p=0.54). However, conjunctival hyperemia was more severe after 1 and 7 days (p=0.04). In both groups, no differences were found concerning intraocular pressure, postoperative hemorrhage or inflammatory reaction (flare) of the anterior chamber and the aspect of the eyelids (p >= 0.14). The number of reoperations resulting from PVR, after 1 month and 1 year, was not significantly different between the two groups (p >= 0.3). The reattachment rate and visual acuity (BSCVA) were not statistically different after 1 year (p >= 0.12). Conclusion: Adjuvant combination therapy using 5-FU and heparin seems to be safe. However, its efficacy needs to be demonstrated by larger studies including eyes presenting a lower grade of PVR (grade B).