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

Lin, Siying; Byles, Daniel; Smith, Michael

doi:10.1038/s41433-018-0199-8

Cited by 11 publications

(20 citation statements)

References 24 publications

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“…As antimetabolites were applied to keep the wound from fibrosis, a similar effect on IOP reduction further validated the efficacy of bleb needling itself. Although long-term studies had proved that the impact could sustain for more than three years but gradually decrease in success rate with time [ 13 , 15 , 24 , 29 ], an overall analysis of the IOP reduction level had shown a stable trend in more than six months in our results. Therefore, we considered that the present meta-analysis provides generalizable information for bleb needling in clinical settings.…”

Section: Discussionmentioning

confidence: 58%

“…IOP reduction levels at six months, one year, two years, and last visit after bleb needling were analyzed. Data at one year were regarded as last-visit data for the studies with loss of >50% cases at the last visit [ 12 , 15 – 17 ]. Combined analysis with a random-effect model showed a significant reduction in IOP at a different timeline ( p < 0.001).…”

Section: Resultsmentioning

confidence: 99%

“…Criteria of success varied among studies. In reviewing the studies, the most accepted definition of complete success was IOP < 21 mmHg or reduction of 20% from baseline without any antiglaucomatous medication [ 2 , 7 , 9 , 11 , 13 , 15 , 19 – 22 , 30 , 31 , 36 , 38 ], while qualified success referred to the same IOP level with topical antiglaucomatous medication [ 7 , 9 , 11 , 12 , 15 , 19 – 22 , 30 , 31 , 36 , 38 ]. Those with criteria stricter than the previously mentioned definition were considered eligible for the pooled analysis of success rate.…”

Section: Resultsmentioning

confidence: 99%

“…The variance of incidence among studies was probably caused by the setting of different trials. Those with a longer duration of follow-up [ 15 , 18 , 29 ] and larger sample size [ 10 , 17 , 25 , 35 ] reported relatively more complications. Typically, Maestrini et al [ 25 ] reported a maximum of 173 cases of postoperative complications in a mean follow-up of 20.8 months for 125 eyes.…”

Section: Resultsmentioning

confidence: 99%

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Safety and Efficacy of Bleb Needling with Antimetabolite after Trabeculectomy Failure in Glaucoma Patients: A Systemic Review and Meta-Analysis

Chen

Suo

Hong

et al. 2020

Journal of Ophthalmology

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Background. Bleb needling with subconjunctival injection of antimetabolites had become a widely accepted approach for trabeculectomy failure. However, IOP reduction effects, success rates, and complications occurrence for this procedure showed great inconsistency among the different studies. Methods. We conducted a literature search on PubMed, Embase, Cochrane Library, and ClinicalTrials.gov. A random-effects model was performed on the extracted data based on the included studies. The intraocular pressure (IOP) and number of antiglaucomatous medications before and after the surgery were pooled for meta-analysis. The success and complication rates were estimated based on the results. Subgroup analysis, sensitivity analysis, and metaregression were applied to explore the origination of heterogeneity. Results. Thirty-seven studies with a total of 2182 patients were finally included in our review. For the present meta-analysis, the overall effects of bleb needling at the last visit revealed a reduction in IOP of 9.74 mmHg (95% confidence interval (CI) [8.85, 10.63]), 45.9% (95% CI [39.0%, 53.0%]) for complete success rate, and 70.4% (95% CI [63.5%, 77.0%]) for qualified success rate. Application of mitomycin C (MMC) and 5-fluorouracil (5-Fu) during the procedure were efficacious for IOP control during the follow-up. Metaregression revealed that possible origination of heterogeneity was baseline IOP before bleb needling, revealing a trend that higher baseline IOP correlated with a greater IOP reduction results p < 0.001 . For safety profile, conjunctival haemorrhage (5.7%, 95% CI [2.5%, 10.1%]), hyphema (5.5%, 95% CI [3.0%, 8.7%]), and bleb leakage (5.0%, 95% CI [3.2%, 7.3%]) had the highest estimate of incidence. An increasing number of needling was the main risk factor for needling failure. Conclusion. Bleb needling with antimetabolites could be considered an effective and safe procedure after trabeculectomy failure. After the process, patients will gain IOP control and reduce antiglaucomatous medications for at least six months with 5-Fu or MMC. Meanwhile, the overall estimates for complications were relatively low in the whole process.

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Section: Discussionmentioning

confidence: 58%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Safety and Efficacy of Bleb Needling with Antimetabolite after Trabeculectomy Failure in Glaucoma Patients: A Systemic Review and Meta-Analysis

Chen

Suo

Hong

et al. 2020

Journal of Ophthalmology

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“…Studies evaluating success of bleb needling for trabeculectomy, ExPress shunt, and XEN gel stent show up to 40% success [ 7 – 9 ]. However, a number of studies evaluating the clinical outcomes after placement of a XEN gel stent report higher early postoperative bleb needling rates up to 44.1% at 1 year [ 4 , 10 – 12 ].…”

Section: Introductionmentioning

confidence: 99%

Comparative outcome analysis of bleb needling of fibrotic blebs in the clinic versus the operating room: a retrospective case series

Ponnusamy¹,

Nguyen²,

An³

2021

BMC Ophthalmol

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Background To compare 6 month outcomes of bleb needling performed in the clinic vs. the operating room (OR) in adult glaucoma patients with failed bleb. Methods A retrospective case series of 47 eyes from 41 glaucoma patients who received needling with mitomycin C (MMC) of scarred bleb from prior bleb-forming procedures in clinic (32 eyes) vs. the OR (15 eyes), including trabeculectomy (14 eyes), ExPress shunt (16 eyes), and ab-interno XEN gel stent (17 eyes). The primary outcome was needling success, defined as IOP ≤ 18 mmHg on 0 glaucoma medications without requiring an additional IOP lowering procedure within 6 months after needling. Results At 6 months, bleb needling success rate was similar when performed in the clinic vs. in the OR (28% vs. 20%, P = 0.54). Success rate was not statistically different in patients with prior trabeculectomy, ExPress shunt, and XEN gel stent (29% vs. 38% vs. 12%, P = 0.26). When comparing clinic vs. the OR needling procedures at 6 months, there was no difference in mean IOP (14.2 vs. 14.9 mmHg, P = 0.73), mean glaucoma medications (1.4 vs. 1.7, P = 0.69), additional IOP-lowering procedure rate (16% vs. 27%, P = 0.37), or complication rate (0% vs. 7%, P = 0.32). Conclusion Bleb needling with MMC in clinic may be a safe and effective way to revise failed bleb after trabeculectomy, ExPress shunt, and XEN gel stent procedures when compared to needling in the OR.

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Primary Open-Angle Glaucoma Preferred Practice Pattern®

Gedde¹,

et al. 2021

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

Cited by 11 publications

References 24 publications

Safety and Efficacy of Bleb Needling with Antimetabolite after Trabeculectomy Failure in Glaucoma Patients: A Systemic Review and Meta-Analysis

Safety and Efficacy of Bleb Needling with Antimetabolite after Trabeculectomy Failure in Glaucoma Patients: A Systemic Review and Meta-Analysis

Comparative outcome analysis of bleb needling of fibrotic blebs in the clinic versus the operating room: a retrospective case series

Primary Open-Angle Glaucoma Preferred Practice Pattern®

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