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Corrado Gizzi, Jibran Mohamed-Noriega, Winifred Nolan, Tuan Ho, David Garway-Heath; Is bleb needling after failed trabeculectomy a procedure worth considering? 5 year outcome with a standardized technique.. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4944.
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© ARVO (1962-2015); The Authors (2016-present)
Restoring adequate intraocular pressure (IOP) control after trabeculectomy failure is challenging for the ophthalmologist. We performed a retrospective analysis of in-theatre needle trabeculectomy revision (‘needling’) to evaluate its efficacy.
We included one eye, selected randomly if both were eligible, of all consecutive patients (n=188) who had needling after failed trabeculectomy with the same technique over a period of 10 years (2004–2014) in a single centre (Moorfields Eye Hospital, London, UK). All interventions were undertaken in theatre with a far superior conjunctival entry. A 29G or 25G needle was used to access the subconjunctival/subtenon space to revive the bleb drainage with one or more of a sequence of steps: breakage of the fibrotic adhesions with sweeping movements of the needle (type 1), identification of the scleral bed and elevation of the overlying scleral flap (type 2), or restoration of the fistula entering the AC with the needle (type 3). All patients had subconjunctival 5-FU and steroids injection at the end. Number of medications and IOP were compared pre and post needling using the paired Student t test. Success was calculated with Kaplan-Meier statistics and defined with Criteria A, B and C when IOP was under 21, 18, 15 mmHg and a reduction of ≥20%, ≥25%, ≥30% from baseline, respectively; for each criterion, success was classified as complete if the patients were off glaucoma drops and qualified if drops were needed.
The mean (SD) IOP at baseline was 22.6 mmHg (6.0) with a mean of 1.6 (1.4) medications (Table 1). Overall success (95%CI) at 1, 2 and 5 years for criteria A were 71.2 (63.1–77.9), 63.3 (54.5–70.8), and 48.9 (36.9–59.8); for criteria B were 60.3 (51.9–67.7), 54.3 (45.6–62.2), and 34.3 (23.8–45.0); for criteria C were 52.4 (44.0–60.1), 41.7 (33.4–49.8), and 22.5 (13.6–32.8) respectively (Figure 1). There was a statistically significant lower mean IOP at last follow up compared to baseline (Table 2). Complications were similar to previous reports with similar long follow-up (Table1).
Our standardized needling technique is an effective option to be considered as first approach to failed trabeculectomy.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Figure 1. Kaplan-Meier survival curves representing the 3 criteria considered for success.
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