Antimetabolite augmented slit-lamp needling for the management of post-trabeculectomy failing bleb.

Abstract

Purpose : To evaluate efficacy and safety of 5 fluorouracil (5-FU) or mitomycin C (MMC) augmented slit-lamp needling to manage post-trabeculectomy failing blebs in a cohort of Latino patients affected by diverse types of glaucoma.

Methods : Four hundred seventeen consecutive cases of trabeculectomy supplemented with intra-operative mitomycin C (MMC) with at least one year follow-up were retrospectively assessed. A total of 75 cases underwent either 5-FU (250 mcg / 0.1ml) or MMC (0.25 mg / 0.1 ml) augmented bleb needling in at least one eye. Major outcome variables were mean decrease of IOP, number of antiglaucoma medications, success rate and presence of complications.

Results : Intraocular pressure decreased from 19.9 ± 5.8 mm Hg (5-FU group) and 20.2 ± 5.1 mm Hg (MMC group) to 15.3 ± 3.6 mm Hg (P = 0.001) and 13.9 ± 3.2 mm Hg (P = 0.001), respectively, at 12 months. Antiglaucoma medications decreased from 2.2 ± 0.8 (5-FU) and 2.5 ± 0.9 (MMC) to 1.8 ± 0.4 (P = 0.0001) and 1.1 ± 0.3 (P = 0.0001), respectively, at 12 months. Global success rate was 72.1% (5FU) and 81.2% (MMC) (P = 0.042), at 12 months. Most common complication was persistent hypotony, presented in 4.7% of the 5-FU group and in the 12.5% of MMC group (P = 0.02).

Conclusions : Antimetabolite augmented slit-lamp needle revision confirms to be an effective and safe option to treat post-trabeculectomy failing blebs in a cohort of Latino patients. MMC might be more effective than 5-FU, although with higher risk of persistent hypotony.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.