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Observational Study
. 2018 Dec;32(12):1893-1899.
doi: 10.1038/s41433-018-0199-8. Epub 2018 Aug 29.

Long-term outcome of mitomycin C-augmented needle revision of trabeculectomy blebs for late trabeculectomy failure

S Lin  1   2 , D Byles  2 , M Smith  3
Affiliations
Observational Study

Long-term outcome of mitomycin C-augmented needle revision of trabeculectomy blebs for late trabeculectomy failure

S Lin et al. Eye (Lond). 2018 Dec.

Abstract

Objectives: To describe the 3-year outcomes of mitomycin C (MMC)-augmented bleb needling procedures following late trabeculectomy failure.

Methods: A retrospective, observational chart review of 44 eyes that underwent MMC-augmented bleb needling following late trabeculectomy failure. The primary outcome measure was IOP at 3 years post-operatively. Secondary outcome measures were the number of topical glaucoma medications and success rate at 3 years. Success was defined on the basis of IOP (≤21 mmHg and ≥5 mmHg with a reduction of ≥ 20% from pre-operative baseline), need for ocular hypotensive medications, and need for further laser or surgical intervention.

Results: Mean IOP was reduced from 19.8 mmHg preoperatively to 13.9 mmHg (29.5% reduction) at 3 years. By the 3-year time point, 26 eyes (59.1%) had met one or more of the criteria for failure. A lower immediate post-operative IOP was found to be associated with greater likelihood of success.

Conclusions: Bleb needling augmented with MMC can achieve a significant reduction in IOP in eyes with late trabeculectomy failure. By 3 years however, 59% of eyes were classified as failures, with half requiring further glaucoma surgery or laser. Patients undergoing this procedure should therefore be warned of the likelihood of requiring further intervention, and a repeat antimetabolite-augmented trabeculectomy or glaucoma tube shunt surgery in the first instance can be considered instead.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
A comparison of pre-operative and post-operative intraocular pressure (IOP) after bleb needling with adjunctive mitomycin C, with a diagonal reference (x = y) line
Fig. 2
Fig. 2
Kaplan-Meier survival analysis after bleb needling with adjunctive mitomycin C. Complete success: IOP ≤ 21 mmHg and ≥5 mmHg with an IOP reduction of ≥20% from pre-operative baseline without the need for any further glaucoma laser or surgical intervention or ocular hypotensive medications. Complete & Qualified success: IOP ≤ 21 mmHg and ≥5 mmHg with an IOP reduction of ≥20% from pre-operative baseline without the need for any further glaucoma laser or surgical intervention, with or without the need for ocular hypotensive medications. The number of eyes “surviving” at each time point is indicated in the risk table
See this image and copyright information in PMC

References

    1. National Institute of Health and Care Excellence (2017). Glaucoma: diagnosis and management. NICE guideline (NG81). p. 13–15. - PubMed
    1. Landers J, Martin K, Sarkies N, Bourne R, Watson P. A twenty-year follow-up study of trabeculectomy: risk factors and outcomes. Ophthalmology. 2012;119:694–702. doi: 10.1016/j.ophtha.2011.09.043. - DOI - PubMed
    1. Skuta GL, Parrish RK., 2nd Wound healing in glaucoma filtering surgery. Surv Ophthalmol. 1987;32:149–70. doi: 10.1016/0039-6257(87)90091-9. - DOI - PubMed
    1. Sherwood MB, Spaeth GL, Simmons ST, Nichols DA, Walsh AM, Steinmann WC, et al. Cysts of Tenon’s capsule following filtration surgery. Medical management. Arch Ophthalmol. 1987;105:1517–21. doi: 10.1001/archopht.1987.01060110063032. - DOI - PubMed
    1. Costa VP, Arcieri ES, Freitas TG. Long-term intraocular pressure control of eyes that developed encapsulated blebs following trabeculectomy. Eye (Lond) 2006;20:304–8. doi: 10.1038/sj.eye.6701865. - DOI - PubMed

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