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. 2022 Dec;70(12):4201-4205.
doi: 10.4103/ijo.IJO_1204_22.

Outcomes of bleb needling in primary glaucoma: A prospective interventional study in a South Indian population

Nikita Das  1 , M Manju  1 , Premanand Chandran  1 , Mrunali Dhavalikar  1 , Padmavathi Sivakumar  1 , Menaka Vimalanathan  1 , Ganesh Venkataraman  1
Affiliations

Outcomes of bleb needling in primary glaucoma: A prospective interventional study in a South Indian population

Nikita Das et al. Indian J Ophthalmol. 2022 Dec.

Abstract

Purpose: This study was conducted to assess the outcomes of bleb needling for the treatment of failure of filtration surgeries in primary glaucoma with a follow-up of six months.

Methods: This prospective interventional study included patients with primary glaucoma who underwent trabeculectomy or combined glaucoma and cataract surgery with failed or failing bleb after six weeks of surgery and less than two years. A comprehensive examination including best-corrected visual acuity (BCVA), intraocular pressure (IOP) measurement, gonioscopy, slit-lamp examination, and bleb morphology grading was done. Selected patients underwent a subconjunctival bleb needling with mitomycin C (MMC) (dose 0.2 mg/ml). Postoperatively, patients were followed up on the first, third, and sixth months and were assessed with respect to IOP, need for antiglaucoma medication (AGM), and complications.

Results: Sixty eyes of 59 patients were included. Preoperatively, 33.3% of patients were on one AGM, whereas postoperatively at the third month 51.7% and at the sixth month 50% of patients were on no AGM. There was a statistically significant decrease in IOP (P < 0.001) from preoperative (mean: 23.8 ± 7.86 mmHg) to postoperative first month (mean: 19.8 ± 9.08 mmHg), third month (mean: 17.4 ± 5.4 mmHg) and sixth month (mean 16.6 ± 4.39). According to the defined criteria in the current study, we achieved 22 (37.9%) successes, 31 qualified successes (53.4%), and 5 (8.6%) failures. Univariate regression analysis showed a higher failure rate among younger age groups. Gender, laterality, and intraoperative complications were not significant statistically.

Conclusion: Bleb needling is a safe and effective procedure for the treatment of failed filtration surgeries.

Keywords: Bleb needling; mitomycin C; trabeculectomy.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
(a) Corneal traction suture for exposing the site of surgery, (b) A 26G needle is used for needling the bleb, (c) A diffuse bleb seen as an end point
Figure 2
Figure 2
Kaplan–Meyer survival analysis for cumulative probability of qualified success
See this image and copyright information in PMC

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