Slit-lamp needle revision of failed filtering blebs using mitomycin C

Abstract

Purpose: The purpose of the study is to determine the efficacy and safety of Mitomycin C (MMC) augmented slit-lamp needle revision of failed filtration surgery.

Methods: The authors retrospectively reviewed the charts of 62 patients (62 eyes) (age, 72 +/- 15 years) with failed filtration surgery who underwent needle revision using MMC. A mixture of 0.01 ml of MMC (0.4 mg/ml) and 0.02 ml of bupivacaine with epinephrine was injected subconjunctivally. Twenty to 30 minutes later, a 30-gauge needle was used to perforate the area of subconjunctival fibrosis and re-establish flow.

Results: Overall, 118 needing procedures (mean, 1.9 +/- 1.4 revisions per eye; range, 1-7) were performed on 62 eyes (mean follow-up, 9.9 +/- 3.7 months; range, 4.5-20.1 months). Thirty-six patients (58.1%) were needled once and 26 patients (41.9%) underwent more than 1 needling procedure. Intraocular pressure decreased from 24.1 +/- 6.4 mmHg (range, 18-44) before surgery to 11.5 +/- 4.8 mmHg (range, 1-26) at last follow-up (P = 5.51 x 10(-21)). Antiglaucoma medications decreased from 1.6 +/- 1.0 to 0.3 +/- 0.6 (P = 3.8 x 10(-14)). Successful single-needling procedure was highly correlated with race (white) and past conventional glaucoma filtration surgery of more than 4 years. Complications included serous choroidal detachment (10 eyes), suprachoroidal hemorrhage (1 eye), bleb leak (5 eyes), iris blocking sclerostomy (2 eyes), hyphema (2 eyes), corneal abrasion (2 eyes), and hypotony (1 eye).

Conclusion: Mitomycin needle revision appears to be an extremely effective way to revive failed filtration surgery. The incidence of complications compares favorably to trabeculectomy with MMC.