Needle Revision with Antimetabolites in Bleb Failure

Abstract

Bleb failure after initially successful glaucoma surgery still constitutes a major challenge in management of glaucoma patients.Needling is considered a simple surgical technique that can solve a major problem like failure of glaucoma surgery.The introduction of antimetabolite in ophthalmology greatly enhances the results of needling as well as the initial trabeculectomy.Mitomycin C(MMC) and 5-Fluorouracil (5FU) used as adjunctive therapy with needling for management of bleb failure with variable success rates but the results with antimetabolites is significantly better than needling alone.In conclusion needling augmented with antimetabolitesis simple technique, relatively safe, fast and has a high success rate, even in complicated glaucoma.

A Degradable Sustained‐Release Drug Delivery System for Bleb‐Forming Glaucoma Surgery

“…[2] During GFS, MMC is administered either intraoperatively by application of sponges soaked in MMC (ranging from 0.2 to 0.4 mg/mL −1 ) into the sub-Tenon's space or postoperatively by injecting MMC into the bleb (0.1 mL of 0.02 mg/mL −1 MMC). [2,5,11,12] MMC is now also used in conjunction with new, less invasive bleb-forming procedures (XEN-gel stent and PRE-SERFLO Microshunt). An additional postoperative treatment with MMC or 5-FU, by injection or needling of the filtering bleb, is needed in ≈ 30-50% of cases after XEN-gel stent implantation, indicating that the intraoperative treatment alone is insufficient in inhibiting the fibrotic response.…”