Early transconjunctival needling revision with 5-fluorouracil versus medical treatment in encapsulated blebs: a 12-month prospective study

Suzuki, Ricardo; Susanna-Jr, Remo

doi:10.6061/clinics/2013(10)14

Cited by 12 publications

(14 citation statements)

References 28 publications

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“…Severe complications such as endophthalmitis, corneal decompensation, choroidal detachment, decompression retinopathy, scleral injury and malignant glaucoma have also been reported. [67]…”

Section: Discussionmentioning

confidence: 99%

Intraoperative optical coherence tomography guided bleb needling

Dada¹,

Angmo²,

Midha³

et al. 2016

J Ophthalmic Vis Res

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Two patients with history of trabeculectomy presented with uncontrolled intraocular pressure (IOP) postoperatively. The first patient had a flat and vasularized bleb 10 weeks after the surgery, and the second subject developed encapsulated bleb 3 months postoperatively. Both patients were taken to the operating room and intraoperative optical coherence tomography (OCT) guided bleb needling was performed to restore aqueous egress into the subconjunctival space. Postoperatively, IOP of the operated eyes ranged 14-18 mmHg at week 6 and month 3. None of the eyes had any intraoperative or postoperative complications. This novel application of the intraoperative OCT for bleb needling facilitates precision surgery under direct visualization and reduces the risk of complications.

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“…Severe complications such as endophthalmitis, corneal decompensation, choroidal detachment, decompression retinopathy, scleral injury and malignant glaucoma have also been reported. [67]…”

Section: Discussionmentioning

confidence: 99%

Intraoperative optical coherence tomography guided bleb needling

Dada¹,

Angmo²,

Midha³

et al. 2016

J Ophthalmic Vis Res

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“…To avoid the progression of glaucomateous visual field defects, the reduction of intraocular pressure is the aim of the treatment for all glaucoma patients (2). Medical treatment usually is the first step of the treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Intraocular pressure (IOP) is a major risk factor for the development and progression of the disease (2). Lowering and controlling the IOP is the primary goal of treatment (2).…”

Section: Introductionmentioning

confidence: 99%

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Bleb yetersizliğinin tedavisinde subkonjonktival 5-fluorourasil kullanımının sonuçları: Olgu serisi

Yılmaz¹,

Aygıt²,

Erdur³

et al. 2015

Ege Tıp Dergisi

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Aim: To evaluate the efficacy of 5-Fluorouracil (5-FU) injections in eyes with bleb failure and uncontrolled intraocular pressure (IOP) after trabeculectomy. Materials and Methods:Fifteen eyes of 15 patients (6 female, 9 male) were included in this retrospective study. All patients had trabeculectomy surgery for the treatment of primary open angle glaucoma. During the first year followups, cases with IOP higher than 21 mmHg and ineffective blebs were considered as bleb failure. We used 5-FU subconjunctival injections, in the same concentration (5 mg) but in different numbers, to treat the bleb failure and lower the IOP. The efficacy of the treatment was evaluated. Results:The mean age was 59.3±12.4 years (range 43-74 years). The mean 5-FU injection count was 5.27±1.58 injections (range 2-7). The mean IOP was reduced to 17.07±7.10 mmHg after treatment. There was a statistically significant difference in IOP levels before and after the injections (p<0.05).Conclusion: 5-FU injection treatment is safe and effective for the treatment of bleb failure after trabeculectomy.Keywords: Trabeculectomy, bleb failure, 5-FU, 5-fluorouracil. Öz Amaç: Trabekülektomi sonrasında bleb yetersizliği ve göz içi basınç (GİB) yüksekliği olan gözlerde 5-Fluorouracil (5-FU) enjeksiyonlarının etkinliğini değerlendirmek. Gereç ve Yöntem: Retrospektif çalışmaya 15 hastanın 15 gözü (6 kadın, 9 erkek) dahil edildi. Tüm hastalar daha önce açık açılı glokom nedeniyle trabekülektomi olmuştu. Birinci yıl takipleri sırasında, GİB'ının 21 mmHg'den yüksek olması ve inefektif bleb varlığı bleb yetersizliği olarak değerlendirildi. Bleb yetersizliğini tedavi etmek ve GİB'ını düşürmek için bu hastalara aynı dozda (5 mg) fakat farklı sayılarda subkonjonktival 5-FU enjeksiyonları uygulandı. Tedavi etkinliği değerlendirildi.Bulgular: idi. Ortalama GİB tedaviyle 17.07±7.10 mmHg'ya düştü. Enjeksiyonlar öncesi ve sonrası dönem arasında GİB seviyelerinde istatistiksel olarak anlamlı düşüş tespit edildi (p<0.05). Sonuç: 5-FU enjeksiyon tedavisi, trabekülektomi sonrası bleb yetmezliği olan vakalarda güvenli ve efektiftir.Anahtar Sözcükler: Trabekülektomi, bleb yetersizliği,

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“…3,4 Proper postoperative management is essential for success during the follow up period. 5 Patients with early postoperative failing blebs typically need maneuvers such as digital massage and release of sutures to maintain adequate pressure control. The 5-fluorouracil (5-FU) when given as repeated subconjunctival injection was shown to improved surgical success in patients with high-risk characteristics when given in the early postoperative period.…”

Section: Introductionmentioning

confidence: 99%

Bleb needling revision with 5-fluorouracil in filtering blebs with chronic failure for over 6 months post-trabeculectomy: a 12-month prospective study

Yodmuang¹

2019

EyeSEA

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Purpose: To evaluate the results of bleb needling revision with adjunctive 5-fluorouracil (5-FU) in chronic filtering bleb failure over 6 months post-trabeculectomy. Method: A prospective study of failed trabeculectomies in a glaucoma clinic between November 2017 and April 2019 were treated with bleb needling revision with 5-FU injection by the same glaucoma specialist and technique. A 27 gauge needle was used to achieve multiple punctures of subconjunctival fibrosis or encystment to attempted elevation of the scleral flap. In all cases, 0.1 ml of 50 mg/ml of 5-FU was then injected subconjunctivally superior to the reformed bleb, and topical prednisolone acetate and moxifloxacin were prescribed. Success was defined as target IOP achieved and maintained less than 21 mmHg without anti-glaucoma medication at 12 months after first needling. Patients were followed up and re-needled as required. Results: Needling was attempted on 51 eyes (30 eyes of POAG, 18 eyes of PACG and 3 eyes of secondary glaucoma). The mean number of needling procedures was 1.88 (range 1-10). Needling was successful in 41 (80.4 %) eyes. The average pre-needling IOP was 24.8 ± 12.6 mmHg and the average post needling IOP was 13.5 ± 7.4 mmHg (P < 0.001) at 12 months after first needling. The mean number of medications pre-needling was 2.6 ± 1.4 and post-needing was 0.3 ± 0.5 (P < 0.001). The mean time post trabeculectomy was 68 months (range 6-120 months). Prognostic factors for failure of needling revision was pre-needling IOP > 25 mmHg (HR = 3.1, P = 0.0003), needling revision ≥ 3 times (HR = 2.6, P = 0.0012) and history of repeated filtration surgery before performed this procedure (HR = 1.8, P = 0.011). Ten eyes (19.6 %) did not respond to needling; 6 eyes of POAG, 3 eyes of PACG and and 1 eye of secondary glaucoma which required revised trabeculectomy, glaucoma drainage device implantation and anti-glaucoma medication. Three eyes had complications; 2 hyphema and 1 hypotony and no other procedures were required. Conclusion: Late bleb needling revision with 5-FU injection is still an effective and lasting treatment for the majority of failed trabeculectomy and avoid further surgery included Thai patients. More than one needling is frequently necessary to achieve target IOP. The procedure is relatively safe, with a short operating time and is minimally invasive with less complications.

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Early transconjunctival needling revision with 5-fluorouracil versus medical treatment in encapsulated blebs: a 12-month prospective study

Cited by 12 publications

References 28 publications

Intraoperative optical coherence tomography guided bleb needling

Intraoperative optical coherence tomography guided bleb needling

Bleb yetersizliğinin tedavisinde subkonjonktival 5-fluorourasil kullanımının sonuçları: Olgu serisi

Bleb needling revision with 5-fluorouracil in filtering blebs with chronic failure for over 6 months post-trabeculectomy: a 12-month prospective study

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