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L.A. Polikoff, J. Danias, D. Wong, J.B. Serle, D.J. Gagliuso, S.M. Podos; Can Needling Success of Failing Filtration Blebs Be Predicted? . Invest. Ophthalmol. Vis. Sci. 2006;47(13):15.
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To identify factors affecting the success rate of antimetabolite–augmented needle lysis of filtering blebs at 3–months and at 1– and 3–years.
Retrospective analysis of all eyes (n=29) that underwent antimetabolite–augmented needle revision of trabeculectomy blebs performed between 1994 and 2004 at the practices of 3 glaucoma specialists was performed with a minimum follow–up of at least 12 months. Kaplan Mayer curves for successful outcome were generated. Success was defined in two different ways: Either an IOP less that 22mmHg (criterion I) or an IOP of less than 22mmHg and IOP reduction > 30% from pre–needling values (criterion II). Success was also considered full or qualified depending on whether medications were used to achieve the target IOP. The relationship between success and patient characteristics of age, sex, race, glaucoma type, pre–needling bleb appearance, time from original surgery, and pre–needling medications were investigated.
Full success as defined by criterion I was achieved in 31% (9/29) of eyes at 3 months but declined to 13.8% at 12 months and 3.4% at 36 months. With the use of ocular hypotensive medications, the qualified criterion I success rates increased to 86.2%, 48.3% and 37.9% at 3 12 and 36 months respectively. Using the stricter definition of criterion II, full success was achieved in 24.1% (7/29) of eyes at 3 months, and 3.4% at 12 and 36 months. Qualified criterion II success rates were 58.6% at 3 months and 20.7% at 12 and 36 months. None of the parameters studied was predictive of success using either definition. No sight–threatening complications were recorded.
Successful antimetabolite–augmented needle revision of filtering bleb does not appear to be related to patient or bleb characteristics. Needle revision is a relatively safe procedure and may provide an alternative to additional incisional glaucoma surgery in some patients.
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