A comparative study of single-barrel and Double-barrel trabeculectomy: efficacy of intraoperative 5-fluorouracil in reducing intraocular pressure

Background: Trabeculectomy is a key surgical approach for managing glaucoma, particularly in patients with high intraocular pressure. This study compares the efficacy of Single-barrel and Double-barrel trabeculectomy techniques utilizing 5-fluorouracil (5-FU) to enhance intraocular pressure (IOP) control and surgical outcomes. Research design and methods: A prospective cohort study of 78 patients (147 eyes) undergoing trabeculectomy with 5-FU was conducted. Patients were divided into Single-barrel and Double-barrel groups. Preoperative and postoperative parameters, including IOP, medication scores, and visual acuity, were assessed. Statistical analyses included propensity score matching, ANCOVA, and Kaplan-Meier survival analysis. Results: Both techniques significantly reduced IOP postoperatively (p < 0.0001). The Double-barrel group demonstrated superior IOP control durability with longer time to failure (10.77 +/- 1.67 months vs. 8.38 +/- 1.72 months, p < 0.001), fewer total failures (11 vs. 15), and a trend toward reduced medication reliance (1.91 +/- 0.80 vs. 2.11 +/- 0.86, p = 0.137). Visual acuity improved in both groups, with a higher proportion of Double-barrel patients achieving 6/6 acuity. Conclusions: The Double-barrel trabeculectomy technique demonstrated superior long-term IOP control and reduced reliance on glaucoma medications, highlighting its potential as a more effective surgical option in glaucoma management.