Needle revision with mitomycin-C in encapsulated blebs

ABSTRACT

The most common cause of failure during the first trimester after trabeculectomy is encapsulated bleb and needling bleb revision is a less invasive method in the management of refractory cases. The purpose of this before-after [paired] observation study was to determine the efficacy and safety of mitomycin-C [MMC] augmented bleb revision of failed filtration surgery. A total of 33 patients with failed trabeculectomy because of bleb encapsulation, whose intraocular pressure [IOP] was not reduced under 21 mmHg despite medication and digital massage, underwent needling bleb revision and subconjunctival injection of 0.1 ml MMC [0.4 mg/ml]. The mean follow-up time was 9.24 +/- 5.27 months [1-20 months]. Statistical analysis of the data included the paired two-tailed Student's t test for preoperative and postoperative IOP and number of medications. A total of 36 needling procedures were performed on 33 eyes. Patients were between 10-80 years old [mean, 45.67 +/- 22.41 years] and mean follow-up was 9.24 +/- 5.27 months. IOP decreased from 29.06 +/- 5.03 mmHg to 18.21 +/- 6.76 mmHg at last follow-up [P = 0.000]. Antiglaucoma medications decreased from 2.18 +/- 0.58 to 1.36 +/- 0.29 at last follow-up [P = 0.000]. Overall, 6 [18.2%] of 33 cases achieved a complete success and 20 [60.6%] of cases achieved a qualified success. The complications of this procedure were subconjunctival hemorrhage [17 cases], hyphema [5 cases] and conjunctival button hole [2 cases]. Needling bleb revision with mitomycin-C appears to be an effective and relatively safe way to revive failed filtration surgery