Treatment outcomes of Mitomycin‐C (MMC) augmented bleb needling in failing trabeculectomy blebs in NHS Tayside

Abstract

PurposeTrabeculectomy is the gold standard surgical option in managing glaucoma when intraocular pressure (IOP) is uncontrolled with topical anti‐hypertensive. Bleb failure is not uncommon in trabeculectomy. Bleb needling is a relatively straightforward procedure that can be conducted to re‐establish flow from the trabeculectomy.1,2 We aim to investigate treatment outcomes of MMC augmented needling of failing trabeculectomy blebs in NHS Tayside.MethodsRetrospective cohort study was performed by reviewing clinical notes of all MMC‐augmented bleb needling procedure after trabeculectomy performed in NHS Tayside from May 2012 to June 2016, patients were identified from surgical records. Data were analysed using IBM® SPSS software and R software (R Foundation for Statistical Computing, Vienna, Austria).Results111 patients were identified, 34 excluded as they were lost to follo‐ ups or did not have clinical notes.86 eyes (77 patients) were included in this study. Median number of months between index filtration surgery and the first needling was 23 months. Mean IOP was reduced by 32.6% by the end of Year 1 (23.94 vs 16.14) and 40.4% by the end of Year 3 (23.94 vs 14.28).This was statistically significant at the 0.05 level.28 eyes (32.6%) required further surgical procedures to control IOP (repeat trabeculectomy, glaucoma drainage device, cyclodiode). 9 eyes (10.5%) had complications related to needling with 3 hyphema, 2 post‐operative needling spike,and 1 each had bleb leak, aqueous misdirection, choroidal effusion and hypotony respectively.ConclusionsBleb needling is a safe procedure that can be carried out re‐establish flow in failing trabeculectomy to achieve satisfactory control.Bibliography1. Lin S, Byles D, Smith M. Long‐term outcome of mitomycin C‐augmented needle revision of trabeculectomy blebs for late trabeculectomy failure. Eye. 2018;32(12):1893‐1899.2. Panarelli J, Vinod K, Huang G, Sidoti P. Transconjunctival Revision With Mitomycin‐C Following Failed Trabeculectomy. Journal of Glaucoma. 2016;25(7):618‐622.