Main Article Content
Objective: To study the outcome of subconjunctival needling with 5-fluorouracil in filtration blebs in the patients who have been treated by trabeculectomy.
Methods: Retrospective chart review of glaucoma patients who have been treated by trabeculectomy or combined phaco-trabeculectomy, and needling revision in accordance to indications at Thammasart University Hospital from January 2015 to December 2017 in total of 52 eyes. The treatment result was monitored during a 6 month- period. Success outcome by monitoring IOP and factors affecting failure of procedure are outcome measurement. In needling procedure, 27-gauge needle and 0.1 mL of 50 mg/mL of 5-FU were used.
Results: After needle revision, mean IOP decreased from 20.5±6.77 mmHg to 13.35±8.11 mmHg at 6 months (p<0.001), median IOP reduction was 29.70%. Complete success, qualified success and failure were at 63.46%, 19.23%, 17.31%, respectively. Incidence rate of failure was 7.92, using Kaplan-Meier survival analysis. Risk factors for failure of 5-FU needling were pre-needling IOP ≥ 25 mmHg (HR 3.81, p=0.047) and secondary
glaucoma including NVG (HR=2.6,p=0.154). In addition, serious complication was not detected after monitoring of treatment for 6 full months.
Conclusion: Bleb needle revision could reduce IOP in the patients who failed filtering bleb and could restore function of bleb in the patients with increasing trends in IOP from bleb morphology which is at safe and effective procedure.
Conflicts of interest: The authors report no conflicts of interest.
2.Paris G, Zhao M, Sponsel WE. Operative revision of non-functioning filtering blebs with 5-fluorouracil to regain intraocular pressure control. Clin Exp Ophthalmol 2004;32(4):378-82.
3.Broadway DC, Bloom PA, Bunce C, Thiagarajan M, Khaw PT. Needle revision of failing and failed trabeculectomy blebs with adjunctive 5-fluorouracil: survival analysis. Ophthalmology 2004;111(4):665-73.
4.Shetty RK, Wartluft L, Moster MR. Slit-lamp needle revision of failed filtering blebs using high-dose mitomycin C. J
5.Kapasi MS, Birt CM. The efficacy of 5-fluorouracil bleb needling performed 1 year or more posttrabeculectomy: a retrospective study. J Glaucoma 2009;18(2):144-8.
6.Liu W, Wang J, Zhang M, Tao Y, Sun Y. Comparison of Subconjunctival Mitomycin C and 5-Fluorouracil Injection for
Eye South East Asia Vol. 14 Issue 1 2019 57 Needle Revision of Early Failed Trabeculectomy Blebs. J Ophthalmol 2016;4:1-6.
7.Lee YS, Wu SC, Tseng HJ, Wu WC, Chang SH. The relationship of bleb morphology and the outcome of needle revision with 5-fluorouracil in failing filtering bleb. Medicine (Baltimore) 2016;95(36):e4546.
8.Anand N, Khan A. Long-term outcomes of needle revision of trabeculectomy blebs with mitomycin C and 5-fluorouracil: a comparative safety and efficacy reportJournal of Glaucoma 2010;20(6):1026-34
9. Feldman RM, Tabet RR. Needle revision of filtering blebs. J Glaucoma. 2008;17(7): 594-600.