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Montserrat Romo Sainz, Jose A Paczka, Yesenia Yolanda Dorantes Diez, Luz America Giorgi Sandoval, Monica Montserrat M Gonzalez Lomeli, Karla J Aguilera Ruiz, Andrea Orozco Garcia; Antimetabolite augmented slit-lamp needling for the management of post-trabeculectomy failing bleb.. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4943.
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© ARVO (1962-2015); The Authors (2016-present)
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.
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.
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).
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.
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