Late Needling of Flat Filtering Blebs with Adjunctive Mitomycin C: Efficacy and Safety for the Corneal Endothelium

Maestrini, Heloísa Andrade; Cronemberger, Sebastião; Matoso, Hérika Danielle S.; Reis, José Roberto C.; Mérula, Rafael Vidal; Diniz, Alberto Filho; Sakurai, Emília; Ferreira, Graziele A.

doi:10.1016/j.ophtha.2010.08.020

Cited by 54 publications

(56 citation statements)

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“…Most of the trabeculectomies fail as a result of fibrosis involving the subconjunctival space, but aqueous resistance can occur at the internal sclerostomy and at the scleral flap as well [17]. There are many ways to manage failed filtering blebs.…”

Section: Discussionmentioning

confidence: 99%

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Bleb Needling with Mitomycin C as Adjunctive Therapy in Failing Blebs: A Retrospective Study

Noce

Vagge

Traverso³

2019

Ophthalmic Res

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Purpose: To evaluate the effects and complications related to use of mitomycin C (MMC) as an adjunctive therapy in bleb needling. Methods: Retrospective review of the records of patients affected by open-angle glaucoma who underwent a bleb revision as a treatment for failed trabeculectomy. All subjects underwent surgery with a fornix-based approach to incision. Full baseline data for each patient included a comprehensive ocular and medical history, the patient’s Snellen visual acuity test results, and Goldmann applanation tonometry test results. Data were reported following observations occurring at 6, 12, 18, 24, and 30 months. In addition, the number and timing of needling with or without MMC subconjunctival injections and any short- and long-term complications were observed. Results: We included 101 patients, 56 (55.4%) male and 45 (44.6%) female. The mean age was 69.81 ± 16.19 years (range 28–92). Statistically significant effects of needling and needling and MMC (p values <0.05) in the decrease in intraocular pressure were observed. Three (2.9%) patients presented hypotony at the last follow-up visit. No other complications were observed. Conclusions: Needling bleb revision augmented with the use of MMC appears to be a more useful tool in the management of failing bleb.

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Section: Discussionmentioning

confidence: 99%

“…Although MMC has some advantages over 5-FU, it is highly toxic to some ocular tissues (especially the corneal endothelium). Therefore, one of the major concerns with the use of MMC remains its safety [17]. However, there is currently no general consensus regarding the use of antimetabolites [27].…”

Section: Discussionmentioning

confidence: 99%

Bleb Needling with Mitomycin C as Adjunctive Therapy in Failing Blebs: A Retrospective Study

Noce

Vagge

Traverso³

2019

Ophthalmic Res

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“…Surgical treatment is the next step after initial medical treatment failure. Trabeculectomy is the gold standard surgery (4). In this procedure, after dissecting a partial thickness scleral flap, a fistula is created between the anterior chamber and the subconjunctival space, and a bleb is formed under the conjunctiva and Tenon's Capsule.…”

Section: Discussionmentioning

confidence: 99%

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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“…Since then, multiple authors have described their outcomes of bleb revision with adjunctive antifibrotic agents after failed filtering surgery. [5][6][7][8][9][10][11][12][13][14][15][16][17][18] This study investigates the efficacy of our technique for TCR of a failed trabeculectomy through a small, posteriorly placed incision using adjunctive MMC. All patients in our study had a patent internal trabeculectomy ostium on gonioscopy and intraocular pressures (IOP) that were judged to be inadequately controlled given the degree of optic nerve damage.…”

mentioning

confidence: 99%

Transconjunctival Revision With Mitomycin-C Following Failed Trabeculectomy

Panarelli

Vinod

Huang

et al. 2016

Journal of Glaucoma

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Late Needling of Flat Filtering Blebs with Adjunctive Mitomycin C: Efficacy and Safety for the Corneal Endothelium

Cited by 54 publications

References 30 publications

Bleb Needling with Mitomycin C as Adjunctive Therapy in Failing Blebs: A Retrospective Study

Bleb Needling with Mitomycin C as Adjunctive Therapy in Failing Blebs: A Retrospective Study

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

Transconjunctival Revision With Mitomycin-C Following Failed Trabeculectomy

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