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L Natanblut, R Shetty, M Moster; Bleb Needle Revision of Failing Trabeculectomies with Mitomycin C . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3345.
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Purpose: To determine the one-year efficacy of bleb needle revision with Mitomycin C (MMC) in patients who failed previous glaucoma filtration surgery. Methods: Charts of 36 patients with one eye that had undergone bleb needle revision with MMC using a mixture of 0.1cc of MMC (.4mg/cc) mixed with .1cc of non-preserved 1% lidocaine were reviewed. All patients with at least nine months of follow-up were included in the study with a mean follow-up time of 11.9 months. A successful bleb needle revision was defined as eyes that did not require subsequent glaucoma filtration surgery after revision and had an intraocular pressure between 5 and 22 mm Hg. A qualified success was defined as successful eyes that needed a second needling or were placed on glaucoma medications. Results: Of the 36 patients with bleb needle revision, 61.1% (22eyes) were determined to be successful of which 45% (10 eyes) were qualified successes. The baseline intraocular pressure in successful patients was 23.7 +/- 5.7 mm Hg (range 9-32 mm Hg) and the average number of glaucoma agents used was 1.6 +/- 1.3 medications. The final intraocular pressure of these patients at one year was 14.3 +/- 3.7 (range 8-21 mm Hg) with an average use of .5 +/- 0.9 medications. An 89% success rate was found in patients that were needled more than one year after the initial filtering surgery while a 40% success rate was found in those revised within 6 months of their initial trabeculectomy. The few complications encountered included hyphema (5 patients), subconjunctival hemorrhage (2 patients), bleb leak (1 patient), and hypotony (2 patients). The hypotony in the two cases lasted less than one week of which one had a self-limited serous choroidal detachment. There were no cases of blebitis, endophthalmitis, or suprachoroidal hemorrhage. Conclusion: Bleb needle revision with MMC in patients with failed glaucoma filtering surgery was found to be an effective method of reviving the filtering site with minimal complications. Higher success rates were achieved when the bleb needle revision was performed after one year from the initial glaucoma filtering procedure.
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