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JC K Clarke, JD A MacLeod; Bleb Needling After Trabeculectomy: Does the effect last . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3372.
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Purpose: A prospective study to assess the long-term results of slit-lamp bleb needling with adjunctive 5-fluorouracil (5-FU). Method: 36 eyes of 34 consecutive patients with failed trabeculectomy seen in a specialist glaucoma clinic (between October 1998 and July 2000 ] were treated with bleb needling. Failed trabeculectomy was defined as inadequately lowered intraocular pressure (IOP) in the presence of a bleb that was encysted, fibrosed or flat. A 29 gauge (insulin) needle was used to achieve multiple puncture of subconjunctival fibrosis or encystment, proceeding if necessary to attempted elevation of the scleral flap. In all cases 5mg of 5-FU in 0.2ml was then injected subconjunctivally superior to the re-formed bleb, and topical dexamethasone and chloramphenicol were prescribed. Patients were followed up and re-needled as required. Results: Needling was attempted on 36 eyes of 34 patients. 3 of these patients were lost to follow up and were excluded from the analysis. 6 eyes did not respond to needling (either too painful or unable to re-form bleb or to reduce IOP). 2 eyes sustained complications (hyphaema or choroidal effusions) and other procedures were required. Of the remaining 25 eyes the mean number of needlings was 1.86 [range 1-5]. Success was defined as "target IOP achieved and maintained". At the conclusion of the study, needling had been successful in 22 (67%) eyes and had failed in 11 (33%) eyes. 8 of the 'failed' eyes required further surgery or cyclodiode. The average pre-needling IOP was 26.8mmHg and the average post needling IOP was 18.6 mmHg (p=0.0002). The mean time since the trabeculectomy was 57 months, range 1-371 months. The mean follow up from first needling was 80.3 weeks (range 9-139) and from last needling was 64.7 weeks (range 5-136) Types of failed bleb were: 31 fibrosed (86%) 3 encysted (8%), 2 flat (6%). 19 patients had also had previous ocular surgery other than trabeculectomy. 20 patients were on topical antihypertensives prior to needling and 16 were on treatment following needling. The mean number of medications pre-needling was 1.50 and post-needing was 1.04 (p=0.03). Conclusion: Bleb needling is an effective and lasting treatment for the majority of failed trabeculectomies. More than one needling is frequently necessary to achieve more than temporary improvement. Significant complications are infrequent.
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