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J. M. Purcell, C. C. Teng, C. Tello, J. M. Liebmann, R. Ritch; Effect of Needle Bleb Revision With Ranibizumab as a Primary Intervention in a Failing Bleb Following Trabeculectomy. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4165.
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To evaluate the effect of needle bleb revision with ranibizumab as a primary intervention in patients with a failing bleb following trabeculectomy.
6 patients were enrolled in this prospective study. All patients had prior trabeculectomy for open angle glaucoma and were deemed to have a failing trabeculectomy requiring needling. Baseline IOP was measured and bleb morphology was characterized. Bleb description was based on vascularity, elevation and number of cysts, graded on a scale of 0 to 4 (0= no change, 1= minimal, 2= mild, 3= moderate, 4= diffuse). Patients were then needled and injected with subconjunctival ranibizumab 0.5 mg (0.05 mL). IOP and bleb characteristics were then assessed for any changes at 1 week and 1 month intervals. The measurements were compared by paired t-test.
6 eyes of 6 patients (3 females, 3 males), mean age 71 ± 7.3 years were enrolled. Mean pre-injection IOP was 27.2 ± 6.4, bleb vascularity 3.3 ± 0.8, bleb elevation 2.3 ± 0.8, bleb cysts 0.8 ± 1.7. At one week, IOP decreased to 14.6 ± 8.3 (p<0.007) and bleb vascularity decreased to 2.3 ± 1.0 (p<0.04). Change in bleb elevation (p<0.39) and bleb cysts (p<0.13) were insignificant. At one month after injection, IOP and vascularity remained decreased. Mean IOP was 14.5 ± 4.9 (p<0.002) and bleb vascularity 1.5 ± 0.8 (p<0.002). There was no statistical difference in elevation (p<0.18) or cysts (p<0.11).
Adjunctive subconjunctival ranibizumab with needling was well tolerated and decreased IOP and vascularity of blebs at 1 week and 1 month follow up. Reduction in bleb vascularity suggests that anti-VEGF therapy may have a role in the treatment of failing bleb following trabeculectomy. Further studies exploring treatment intervals and applications are warranted.
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