Bleb Needling with Mitomycin C as Adjunctive Therapy in Failing Blebs: A Retrospective Study

Abstract

Purpose: To evaluate the effects and complications related to use of mitomycin C (MMC) as an adjunctive therapy in bleb needling. Methods: Retrospective review of the records of patients affected by open-angle glaucoma who underwent a bleb revision as a treatment for failed trabeculectomy. All subjects underwent surgery with a fornix-based approach to incision. Full baseline data for each patient included a comprehensive ocular and medical history, the patient’s Snellen visual acuity test results, and Goldmann applanation tonometry test results. Data were reported following observations occurring at 6, 12, 18, 24, and 30 months. In addition, the number and timing of needling with or without MMC subconjunctival injections and any short- and long-term complications were observed. Results: We included 101 patients, 56 (55.4%) male and 45 (44.6%) female. The mean age was 69.81 ± 16.19 years (range 28–92). Statistically significant effects of needling and needling and MMC (p values <0.05) in the decrease in intraocular pressure were observed. Three (2.9%) patients presented hypotony at the last follow-up visit. No other complications were observed. Conclusions: Needling bleb revision augmented with the use of MMC appears to be a more useful tool in the management of failing bleb.

Numerical model to predict and compare the hypotensive efficacy and safety of minimally invasive glaucoma surgery devices

“…In our simulation, the decrease in IOP ranged from 29% to 22%, while the bleb pressure ranged from 17 to 20 mmHg. It is important to consider that, in routine clinical practice, manoeuvres such as needling of the filtration bleb are usually performed from 6 months to one year after surgery to prevent excessive scar formation, which could lead to more flow resistance in the bleb [49,50].…”

Primary Open-Angle Glaucoma Preferred Practice Pattern®

“…463,464 Transconjunctival needling with 5-FU or MMC has been shown to be effective in reviving failing filtering blebs. [465][466][467][468][469][470][471][472][473][474][475][476][477] Open trabeculectomy revision with MMC has also demonstrated success in reestablishing aqueous outflow. 478,479 The use of an antifibrotic agent carries with it an increased risk of complications such as hypotony, [480][481][482] hypotony maculopathy, 480 late-onset bleb leak, 457,483 and late-onset infection [484][485][486] that must be weighed against the benefits when deciding whether to use these agents.…”