Abstract
Abstract: :
Purpose: Needling revision of filtration blebs is used to regain control of intraocular pressure after filtration begins to fail. The literature supports a 50% success rate of improved intraocular pressure control after a needling revision. A small group of patients were assigned to the standard procedure and the modified procedure to ascertain if the success could be improved with a minor modification. Methods: 16 eyes from 16 patients who were identified to have failure of control of glaucoma due to decreased filtration through the bleb underwent needling revision, all with adjunctive use of 5-fluorouracil. The eyes were assigned to the standard procedure (group A) and modified procedure (group B) in an alternating fashion. The only modification between the groups was the use of a 25 gauge needle instead of a 27 gauge needle which had always been used previously. Results: The 8 eyes in group A which underwent the standard procedure had a success rate of 50% (4/8). The 8 eyes in group B which had the procedure done with the 25 gauge needle had a success rate of 75% (6/8). The IOP was similar for the two groups prior to the procedure, A = 24.5±6.4 mmHg and B=25.2±5.8 mmHg, P=.1. Success was defined as a 30% reduction of IOP with no additional medications at three months. The IOP at 3 months for the group considered a success in A=15.5±4.4 mmHG and in B=11.5±2.3 mmHg, P<.005. The IOP in the eyes considered a needling failure were similar, the IOP in A=18.8±6.3 mmHg and B=19.6±4.5 mmHg, P=.2. The number of medications for the eyes failing needling revision was at least 4 medications for all eyes (range 4-5). There were no significant complications for any of the eyes. The amount and duration of wound leaks was greater in group B, P<.005. Leaks for more than 1 week existed for 3/8 of the eyes in group B and only 1/8 in group A. All leaks sealed by one month. Conclusions: A single change of a larger gauge needle in the hands of one glaucomatologist significantly increased the success rate of needling bleb revisions. The amount of IOP reduction and the percent of successful needlings was significantly improved by this one modification.
Keywords: clinical (human) or epidemiologic studies: sys • clinical (human) or epidemiologic studies: out