Needling Revision Outcomes Following Glaucoma Filtering Surgery

Abstract

Purpose: To evaluate the success of needling bleb revision performed in the treatment room following failure of filtering glaucoma surgery.

Methods: Retrospective chart review of 132 patients who underwent bleb needling revision, with and without sub-conjunctival anti-proliferative, after failure of glaucoma filtering surgery. Success was defined by intraocular pressure (IOP) ≤ 18 with ≤ 2 pressure lowering medications. Kaplan-Meier survival analysis was performed and success was determined based on percent survival at median follow up time. Failure occurred if IOP or medications exceeded criteria, or any subsequent glaucoma procedure, including repeat needling and laser procedures.

Results: Mean age for our population was 67.4 (± 13.9) years. Seventy three percent were African American. Females comprised 56% of the group. Mean pre-needling IOP was 26.2 (± 9.5) mmHg, while mean pre-needling number of medications was 2.2 (± 1.5). Seventy nine percent had primary open angle, while 11.9% had angle closure, and 4% had uveitic glaucoma. Mean post-needling IOP at 24 months was 16.5 (± 1.6) mmHg. Success was 30% at 24 months.

Conclusions: Our rate of success at 24 months was similar to previous reports. With more moderate criteria of IOP ≤ 21 with ≤ 3 medications, success rate increases to 42%. Bleb needling revision, in patients following failed glaucoma filtration surgery, may be effective in postponing or eliminating need for further invasive glaucoma surgery.