Long-Term Outcomes of Bleb Needling With Intraoperative Transconjunctival Mitomycin-c Application

Abstract

Purpose: : To report long-term outcomes of bleb needling with intraoperative transconjunctival mitomycin-C application (ITMA).

Methods: : Retrospective chart review of 119 eyes (119 patients) that underwent needle revision of a failing filtering bleb with ITMA. A 25-G needle was used and the entry site was sutured. This was followed by ITMA (0.5 mg/ml) with sponges kept in contact with the conjunctival epithelium for 6 minutes. Success was defined as ≥30% decrease in IOP with/without medications and no major complications/further surgery.

Results: : Mean age was 67±16 yrs; 55% were female, 68% were Caucasian, 71% had POAG and 60% were pseudophakic. Mean follow-up was 44.2±37.4 months. Baseline IOP of 19.9±5.6 mmHg was reduced by 6.1±3.9 mmHg at the end of follow-up. Average number of medications before and after surgery was 1.8 ±1.2 and 1.1±1.3 (p = 0.0001), respectively. Cumulative probability of success was 87%, 78%, 64% and 61% at 6, 12, 18, and 24 months, respectively. 44/119 eyes (37%) required further IOP lowering surgery. 97 eyes (82%) received post-operative 5-FU injections (average number was 5.1±3.4). Immediate post-op complications included self-limiting hyphema in 5 eyes (4.2%) and choroidal hemorrhage in 2 eyes (1.7%, both underwent choroidal drainage). Late complications included bleb leak in 6 eyes (5%), blebitis in 5 eyes (4.2%) and hypotony in 3 eyes (2.5%); all resolved with conservative management. Cox regression analysis showed significantly longer survival for younger patients (r = 0.97, p<0.001) and those who received 5-FU (r =2.03 and p=0.03). Of those who received 5-FU, the use of ≥ 5 injections improved survival (r=1.92, p=0.04).

Conclusions: : Bleb needling with ITMA and post-operative 5-FU was effective in lowering IOP in the short to intermediate term.

Keywords: injection • wound healing • clinical (human) or epidemiologic studies: outcomes/complications