Results From a Modified Bleb Needling Procedure With Continuous Infusion Performed in the Operating Room

Abstract

A modified bleb needling procedure performed in the operating room can successfully lower IOP in the setting of a previous trabeculectomy in over 60% of subjects a year after the procedure.

Factors predicting the success of trabeculectomy bleb enhancement with needling

“…This suggests that when conditions such as patient comfort or orbital anatomy preclude a thorough dissection in the clinic, there should be a low threshold to use the operating room for additional tools such as traction suture and anterior chamber maintainer to facilitate a thorough dissection 15. Our data also concurs that the risk of hypotony and the consequences of hypotony after needling are substantially less than after trabeculectomy.…”

“…Likewise, variations in antifibrosis treatments include injection of 5-fluorouracil (5FU) into the subconjunctival space,6–8 or into the bleb,9 10 or mitomycin C applied topically (transconjunctival)11 or by subconjunctival injection 12–14. Although innovation continues,15 shared principles have resulted in a widespread technique for bleb enhancement by needling used here.…”

Ab interno bleb needling revision: a new approach

“…A recent bleb needling technique has been described by Wilson et al, utilizing continuous infusion performed in the operating room. 1 The balanced salt solution keeps the anterior chamber formed and avoids the need for ophthalmic viscosurgical device. The ab interno technique requires careful passing of the needle across the anterior chamber to avoid collateral damage to intraocular structures, particularly if the patient is phakic.…”

“…Graham A Lee MD FRANZCO, 1,2,3 Desirée Murray FRCOphth 4 and Peter Shah FRCOphth 3,5,6 1 City Eye Centre, 2 The Lions Outback Vision Van was launched in March 2016 and is a mobile eye clinic providing ophthalmology care to regional and remote Western Australia. For the first time, we have been able to bring essential equipment to regional and remote towns to improve the delivery of our ophthalmology service (Figs 1, 2 We present two cases that highlight the benefits of this equipment during pre-operative assessment, which were previously unavailable at rural locations.…”