Long-Term Effect of Post-Trabeculectomy MMC-Suplemented Needling among Patients with End-Stage Glaucoma.

Abstract

Purpose : Glaucoma at the most advanced stages requires maximum IOP control. Trabeculectomy is a frequently used approach for such purpose. On this respect, fibrosis of the filtration site is one of the main reasons for primary failure of trabeculectomy. Needle revision with adjunctive antimetabolites is an effective, simple and low cost method of re-establishing filtration in eyes with failed filtering blebs. The aim of the study was to evaluate long-term intraocular pressure IOP control and associated complications in end-stage cases of glaucoma after mitomycin-C (MMC) supplemented slit-lamp needling to manage post-trabeculectomy failing blebs.

Methods : A retrospective review of 26 consecutive cases of end-stage glaucoma which underwent MMC-supplemented needle revision after trabeculectomy failure in a glaucoma specialized center in Western Mexico with at least 7 years of follow-up. At least one eye of the studied cases underwent slit-lamp MMC (0.25 mg / 0.1 ml) augmented bleb needling for one or more times during a minimum period of 7 years of follow-up. Variables under analysis were baseline and post-needling IOP, number of antiglaucoma medications, collateral procedures, need of digital compression, success surgical rate (pre-established criteria) and presence of complications.

Results : Mean age of participants was 62.8 ± 8.9 years (16 female, 10 male). Most of them with POAG (57.7%). Mean IOP decreased from 20.42 ± 3.17 mm Hg to 12.7 ± 2.29 mm Hg (P = 0.0001) at 7 years. More than one needling procedure was performed in 53.8% of the cases. Mean antiglaucoma medications decreased from 3.19 ± 0.69 to 0.53 ± 0.81 (P = 0.0001), respectively, at the final visit. Overall success rate was 73.07% after 7 years of follow-up. Decreased BCVA more than 2 lines (including 2 cases of lost light perception) was present in 4 cases. Three cases required further glaucoma surgery.

Conclusions : MMC-supplemented slit-lamp needle revision is a fairly effective and safe option to treat post-trabeculectomy failing blebs in end-stage glaucoma cases in the long-term. More than one needling revision is frequently needed to achieve IOP control.

This is a 2020 ARVO Annual Meeting abstract.