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Toby Al-Mugheiry, Jonathan Than, Jesse Gale, Keith R Martin; Needling procedures following trabeculectomy – predictive factors and a retrospective study of outcomes. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4942.
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To measure the ocular hypotensive effect of needling revision procedures performed post-trabeculectomy at Addenbrooke’s Hospital in glaucoma patients over a 10 year period as well as assessing risk factors that predict the success or failure of needling.
Retrospective case series of 91 patients (96 eyes) who had undergone post-trabeculectomy needling during this period, with at least 1 year follow-up post-procedure. Success was defined with respect to intraocular pressure (IOP) targets (21 and 18mmHg) qualified by the need for topical anti-glaucoma medications. Bleb morphology was a secondary outcome described at each visit. Relevant risk factors were analysed retrospectively against both success criteria via Cox proportional hazards regression analysis.
The mean (±SD) follow-up period was 3.09±1.75 years. Median interval between trabeculectomy and first needling was 41.5 days. The mean IOP for all eyes reduced from 24.6±8.1 mmHg immediately pre-needling to 13.2±6.6 mmHg (p<0.0001) at the first postoperative check. Complete success (IOP<21mmHg, without new medications) was 72% at final follow-up. Complete success (IOP<18mmHg, without new medications) was 53% at final follow-up. Survival curves indicated most of the failure of needling occurred in the first few months after the procedure. There was a significant change in description of bleb morphology with fewer flat or fibrotic blebs and more diffuse blebs 1 year after needling (chi-square with Yates correction = 45.9, p<0.0001). Risk factors predicting failure of the needling were an IOP >10mmHg at first post-needling check, and a non-injected bleb morphology before needling. A period greater than 90 days between trabeculectomy and first bleb needling was a significant risk factor for failure defined by IOP>21mmHg. No clinically important adverse outcomes were identified.
Needling represents a useful intervention following trabeculectomy which may be preferable to medication or more invasive methods of controlling IOP. The ocular hypotensive effect was maintained for at least a year in the majority of patients. Bleb morphology was a predictor of trabeculectomy survival and of needling success. Achieving a low IOP immediately following trabeculectomy needling has a favourable outcome.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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