Needle revision outcomes after glaucoma filtering surgery: survival analysis and predictive factors

Abstract

Purpose: To evaluate the efficacy and safety of needle revision and examine factors predictive of failure. Methods: In total, 157 eyes of 131 patients that underwent needle revision augmented with either 5-fluorouracil or betamethasone for trabeculectomy failure were included in this retrospective study. Complete failure was defined as additional glaucoma surgery, ciliodestructive procedures, loss of light perception, sight-threatening complications, hypotony maculopathy, and surgical bleb revision. Success was defined as intraocular pressure ⩽ 18 (criterion A), ⩽15 (criterion B), and ⩽12 mmHg (criterion C) reached with (qualified) or without (complete) medications, and absence of any criteria of complete failure. Results: The median (interquartile range) follow-up was 25.0 (41.0) months. Complete failure rates were 19%, 26%, and 31% at 1, 2, and 3 years, respectively. For criterion A, qualified and complete success rates were, respectively, 77% and 69% at 1 year, 66% and 51% at 2 years, and 60% and 47% at 3 years. For criterion B, qualified and complete success rates were, respectively, 67% and 61% at 1 year, 48% and 42% at 2 years, and 44% and 39% at 3 years. For criterion C, qualified and complete success rates were, respectively, 43% and 41% at 1 year, 27% and 25% at 2 years, and 24% and 23% at 3 years. High baseline intraocular pressure and primary surgery were associated with higher and lower risks of complete failure, respectively. Conclusion: Needle revision is an effective and safe procedure to rescue failing trabeculectomy postponing or avoiding further glaucoma surgery. Eyes with low target intraocular pressure may have poor long-term outcomes.

Blood Reflux Through a PreserFlo MicroShunt Device After Needling

“…According to the literature, this type of adverse event has been described after classic filtration surgery (trabeculectomy), no mention of minimally invasive glaucoma surgery devices or of bleb filtering surgery has been referred. 15 In our case, needling revision after a PreserFlo MicroShunt implantation caused heavy bleeding in the anterior chamber from a filtering bleb, with an IOP rise. The condition improved slowly and resolved within 14 days after.…”

“…Most reports describe cases of hyphema after needling in patients who underwent trabeculectomy, nevertheless the site of the anterior chamber bleeding is not specified. According to the literature, this type of adverse event has been described after classic filtration surgery (trabeculectomy), no mention of minimally invasive glaucoma surgery devices or of bleb filtering surgery has been referred 15…”

Safety and Efficacy of the Rho-Kinase Inhibitor (Ripasudil) in Bleb Needling after Trabeculectomy: A Prospective Multicenter Study

“…Helosa A. et al reported that there was no significant difference in preoperative corneal endothelial cell density at 12 months [18]. However, several studies indicated that the subconjunctival injection of antimetabolites can cause severe damage to corneal endothelial cells [26][27][28][29]. While such complications are rare, they cannot be resolved through observation or treatment with ocular instillation and may require corneal transplantation.…”

“…ROCK inhibitors were reported to have the potential to improve corneal endothelial diseases, such as Fuchs endothelial dystrophy or corneal edema, and to have a protective effect on corneal endothelial cells after cataract surgery [ 30 , 31 , 32 , 33 , 34 ]. The exact mechanism by which ROCK inhibitors improve corneal endothelial cells has not been fully elucidated, but it is possible that these promote the reactivation of cell proliferation and migration, and the restoration of the corneal endothelial pump and barrier functions, contributing to the regeneration of corneal endothelial cells [ 29 , 35 ]. In this study, there was no change in corneal endothelial cell density more than 12 weeks after the needling surgery.…”

XEN45 real-life evaluation: Survival analysis with bleb needling and major revision outcomes

“…As in any bleb-forming procedure, [19][20][21] postoperative management may be required to optimize its function. In line with our BN rate of 30%, recent publications have reported approximately 30%-40% postoperative needling rates in both retrospective 9,10 and prospective 12,22 studies but it can be as high as 62% of BN when more than one needling is performed in the same eye.…”