Needle revision of failed filtering blebs using mitomycine C in congenital glaucoma

ABSTRACT

To evaluate efficacy and safety of needling procedure in management of failed bleb [either flat or encapsulated] after SST [subscleral trabeculectomy] in most cases and Ahmed Glaucoma valve in some cases in patients with congenital glaucoma. 26 eyes of 20 patients with bleb failure in 24 eyes bleb failure after SST and 2 eyes bleb failure after Ahmed Glaucoma valve [7.7%]. All were from Ain Shams University Hospital. Out patient clinic and of the same social class and age group [9 months to 5 years]. Needling procedure with adjunctive use of MMC. Amixture of 0.01 ml of MMC [0.4 mg/ml] and 0.02 ml of lidocain 1% with epinephrine was injected subconjuctivally before needling procedure which done under general anesthesia in all cases. A 30- gauge needle was used to perforate the area of subconjunctival fibrosis and reestablish flow. Gonioscopy was done in all cases, patients with internal ostium obstruction were excluded from. study. In 26 eyes of 20 patients followed up for 6 months or more. 21 [80.7%] of 26 eyes received one needle revision and 5 [19.3%] of 26 received two needle revisions. Only one of 5 cases [20%] succeeded and the remaining 4 cases had been failed [80%]. Intaocular pressure decreased from 27.08 +/- 2.95 mm Hg [range 22-32 minHg] before surgery to 16.54 +/- 3,25 mm Hg [range 12-24 mm Hg] at last follow up antiglaucoma medications decreased from 1.46 +/- 0.508 preoperativelv to 0.615 +/- 0.752 post operatively. Complications include significant subconjunctival hemorrhage in [6 cases]. Bleb leak observed in 2 cases intra operatively. Hypotony from choroidal detachment observed in one case minimal hyphema observed in one case. Mitomycine needle bleb revision appears to be an extremely effective way to revive failed filtration surgery either after SST or Ahmed Glaucoma value in patients with congenital glaucoma. This technique is efficient for proper reduction of IOP with preservation of the remaining of the conjunctive in case of further surgery becomes necessary