Needle Revision of Failed Filtering Blebs Using 5- Fluorouracil and a Combined Ab-Externo and Ab-Interno Approach

Pasternack, James; Wand, Martin; Shields, M. Bruce; Abraham, Deepa

doi:10.1097/00061198-200502000-00009

Cited by 37 publications

(17 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In some studies, the success rates range from 54% to 84% at 1 year, depending on different definition of success and case selection. 13,14,15,16,17 In the present study, we reported efficacy of this procedure in chronic filtering bleb failure over 6 months after trabeculectomy in Thai eyes with 80.4 % success rate without serious visual threatening complications. We also reported on factors associated with procedural failure.…”

Section: Discussionmentioning

confidence: 65%

Bleb needling revision with 5-fluorouracil in filtering blebs with chronic failure for over 6 months post-trabeculectomy: a 12-month prospective study

Yodmuang¹

2019

EyeSEA

View full text Add to dashboard Cite

Purpose: To evaluate the results of bleb needling revision with adjunctive 5-fluorouracil (5-FU) in chronic filtering bleb failure over 6 months post-trabeculectomy. Method: A prospective study of failed trabeculectomies in a glaucoma clinic between November 2017 and April 2019 were treated with bleb needling revision with 5-FU injection by the same glaucoma specialist and technique. A 27 gauge needle was used to achieve multiple punctures of subconjunctival fibrosis or encystment to attempted elevation of the scleral flap. In all cases, 0.1 ml of 50 mg/ml of 5-FU was then injected subconjunctivally superior to the reformed bleb, and topical prednisolone acetate and moxifloxacin were prescribed. Success was defined as target IOP achieved and maintained less than 21 mmHg without anti-glaucoma medication at 12 months after first needling. Patients were followed up and re-needled as required. Results: Needling was attempted on 51 eyes (30 eyes of POAG, 18 eyes of PACG and 3 eyes of secondary glaucoma). The mean number of needling procedures was 1.88 (range 1-10). Needling was successful in 41 (80.4 %) eyes. The average pre-needling IOP was 24.8 ± 12.6 mmHg and the average post needling IOP was 13.5 ± 7.4 mmHg (P < 0.001) at 12 months after first needling. The mean number of medications pre-needling was 2.6 ± 1.4 and post-needing was 0.3 ± 0.5 (P < 0.001). The mean time post trabeculectomy was 68 months (range 6-120 months). Prognostic factors for failure of needling revision was pre-needling IOP > 25 mmHg (HR = 3.1, P = 0.0003), needling revision ≥ 3 times (HR = 2.6, P = 0.0012) and history of repeated filtration surgery before performed this procedure (HR = 1.8, P = 0.011). Ten eyes (19.6 %) did not respond to needling; 6 eyes of POAG, 3 eyes of PACG and and 1 eye of secondary glaucoma which required revised trabeculectomy, glaucoma drainage device implantation and anti-glaucoma medication. Three eyes had complications; 2 hyphema and 1 hypotony and no other procedures were required. Conclusion: Late bleb needling revision with 5-FU injection is still an effective and lasting treatment for the majority of failed trabeculectomy and avoid further surgery included Thai patients. More than one needling is frequently necessary to achieve target IOP. The procedure is relatively safe, with a short operating time and is minimally invasive with less complications.

show abstract

Section: Discussionmentioning

confidence: 65%

Bleb needling revision with 5-fluorouracil in filtering blebs with chronic failure for over 6 months post-trabeculectomy: a 12-month prospective study

Yodmuang¹

2019

EyeSEA

View full text Add to dashboard Cite

show abstract

“…Mazey et al described reversible corneal edema due to endothelial damage 26. However, the potential for more serious complications, such as kissing choroidal detachment,27 suprachoroidal hemorrhage,8 malignant glaucoma,19 and enodophthalmitis,8 should not be overlooked.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of repeated 5-fluorouracil needling for failing and failed filtering surgeries based on simple gonioscopic examination

Rashad¹

2012

OPTH

View full text Add to dashboard Cite

PurposeTo evaluate the success rate of a modified bleb needling technique in eyes with previous glaucoma surgery that had elevated intraocular pressure.MethodsA retrospective study of 24 eyes of 24 patients that underwent repeated bleb needling performed for failing and failed blebs on slit lamp with 5-fluorouracil (5-FU) injections on demand. This was performed after gonioscopic examination to define levels of filtration block.ResultsThere was significant reduction of mean IOP from 36.91 mmHg to 14.73 mmHg at the final follow-up (P < 0.001). The overall success rate was 92%.ConclusionRepeated needling with adjunctive 5-FU proved a highly effective, safe alternative to revive filtration surgery rather than another medication or surgery.

show abstract

“…On the other hand, both cornea and sclera are relatively avascular tissues, implying that long-term adhesion of the partial thickness flaps on their underlying beds may be incomplete. The fact that both corneal flap (in LASIK) and partial thickness scleral flap (in trabeculectomy) can be re-raised in cases of revision of the initial procedure further supports this concept [12–15]. …”

Section: Discussionmentioning

confidence: 99%

Differences between Goldmann Applanation Tonometry and Dynamic Contour Tonometry following Trabeculectomy

Detorakis

Grammenandi

Pallikaris

2010

Journal of Ophthalmology

View full text Add to dashboard Cite

Background. To evaluate differences between Goldmann Applanation Tonometry (GAT) and Dynamic Controur Tonometry (DCT) following trabeculectomy. Methods. Thirty eight glaucomatous eyes with a history of trabeculectomy (Trabeculectomy group, TG), 20 eyes without a history of trabeculectomy but with a history of latanoprost use (Latanoprost group, LG), and 19 nonglaucomatous eyes (Control group, CG) were included. GAT-IOP, DCT-IOP, the difference between them (dIOP), the central corneal thickness (CCT), the axial length (AL), and the depth of the anterior chamber (ACD) were measured. Results. dIOP was significantly higher in TG (5.19 mmHg) than in LG (4.01 mmHg) and CG (1.98 mmHg). Correlations between AL and dIOP were statistically significant in both TG and LG but not in CG whereas correlations between dIOP and other clinical parameters examined were statistically not significant in all groups. Conclusions. The significantly higher dIOP in TG implies that the bio-mechanical properties of the ocular walls are altered following trabeculectomy.

show abstract

Needle Revision of Failed Filtering Blebs Using 5- Fluorouracil and a Combined Ab-Externo and Ab-Interno Approach

Abstract: In failed filtering blebs, needle revision with 5-Fluorouracil and a combined ab-externo and ab-interno approach results in high success and low complication rates. The outcome of this procedure compares favorably with previously reported revision techniques.

Cited by 37 publications

References 11 publications

Bleb needling revision with 5-fluorouracil in filtering blebs with chronic failure for over 6 months post-trabeculectomy: a 12-month prospective study

Bleb needling revision with 5-fluorouracil in filtering blebs with chronic failure for over 6 months post-trabeculectomy: a 12-month prospective study

Efficacy of repeated 5-fluorouracil needling for failing and failed filtering surgeries based on simple gonioscopic examination

Differences between Goldmann Applanation Tonometry and Dynamic Contour Tonometry following Trabeculectomy

Contact Info

Product

Resources

About