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. 2018 Jan;66(1):71-76.
doi: 10.4103/ijo.IJO_523_17.

Rescue of failing or failed trabeculectomy blebs with slit-lamp needling and adjunctive mitomycin C in Indian eyes

Vanita Pathak-Ray  1 , Nikhil Choudhari  2
Affiliations

Rescue of failing or failed trabeculectomy blebs with slit-lamp needling and adjunctive mitomycin C in Indian eyes

Vanita Pathak-Ray et al. Indian J Ophthalmol. 2018 Jan.

Abstract

Purpose: The aim of this study is to investigate the efficacy and safety of needling-revision augmented with a high dose of mitomycin C (MMC) in failing or failed blebs after trabeculectomy in Indian eyes.

Methods: Prospective, noncomparative, interventional study. All patients (>18 years) who had raised intraocular pressure (IOP) following trabeculectomy (>6 weeks and <2 years), who had a flat bleb, bleb encapsulation, and/or required antiglaucoma medication (AGM) for IOP control were eligible for inclusion. MMC was injected subconjunctivally at least ½ hour before the needling procedure was carried out at the slit lamp in the outpatient's clinic.

Results: Thirty-nine eyes of 38 patients were included. The median follow-up was 20 months and time interval between trabeculectomy and needle revision was 113 days. Initially, in all cases, aqueous flow was re-established with a raised bleb; 7 eyes required repeat needling. IOP decreased from median 24 mmHg (Q1 21, Q3 27, interquartile range [IQR] 6, range 18-35) preneedling to median 14 mmHg (Q1 10, Q3 16, IQR 6, range 6-18) postneedling at last follow-up (P < 0.0001, 95% confidence interval [CI]: 8.2-13.0). The use of AGM reduced from median 1 (Q1 0, Q3 3, IQR 3, range 0-4) preneedling to median 0 postneedling (P < 0.0001, 95% CI: 1-2). Complete success was seen in 28 eyes (71.8%, 95% CI: 71.1%-96.4%); another 5 eyes (12.8%) were controlled with AGM (qualified success) with overall success of 84.6%. Most complications were transient in nature with resolution within 1 week. One patient developed hypotony, and another developed a late bleb leak.

Conclusion: Needling revision augmented with high-dose MMC, at the slit lamp, effectively rescues failing or failed filtration, and appears to be safe.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Median intraocular pressure (mmHg) pre- and post-needling with Mitomycin C at all time intervals after procedure
Figure 2
Figure 2
Kaplan–Meier cumulative survival curve for all needling procedures
Figure 3
Figure 3
Appearance of bleb. (a) Preneedling; intraocular pressure 34 mmHg on 3 antiglaucoma medication. (b) Immediate postneedling diffuse bleb; intraocular pressure 10 mmHg with subconjunctival hemorrhage. (c) Postneedling 1 week resolution of subconjunctival hemorrhage; intraocular pressure 16 mmHg. (d) Postneedling 1 year; intraocular pressure 10 mmHg, no antiglaucoma medication
See this image and copyright information in PMC

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