Needle Revision With and Without 5-Fluorouracil for the Treatment of Failed Filtering Blebs

Ewing, Robert H.; Stamper, Robert L.

doi:10.1016/s0002-9394(14)76340-8

Cited by 105 publications

(79 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[11][12][13] It is possible that repeated needling might have improved our results. However, repeated needling procedures without antimetabolites may stimulate fibroblastic proliferation even more, and may increase the risk of endophthalmitis, choroidal detachment, and shallow anterior chamber.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors suggested that needling with adjunctive 5-FU or MMC may inhibit fibroblastic proliferation, increasing the success rates of this procedure. 12,13 BenSimon and Glovinsky 19 reported a 76% success rate of needling with MMC in 41 eyes 6 months after the procedure. Mardelli et al 16 reviewed the charts of 62 eyes with failed filtering blebs that underwent needle revision using MMC and observed that the IOP decreased from 24.176.4 mmHg before needling to 11.574.8 mmHg at the last follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…They normally occur 2-4 weeks following filtering surgery and are frequently associated with increased intraocular pressures (IOPs). [1][2][3][4][5] Different treatment modalities have been suggested to reduce the IOP of eyes with EBs, including the use of aqueous humor suppressors, 6-10 digital massage, [6][7][8][9][10] transconjunctival needling, [11][12][13][14] and surgical revision of the bleb. 11,12,15 Medical treatment with aqueous humor suppressors has been shown to be successful in controlling the IOP immediately after the development of an EB.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5] Different treatment modalities have been suggested to reduce the IOP of eyes with EBs, including the use of aqueous humor suppressors, 6-10 digital massage, [6][7][8][9][10] transconjunctival needling, [11][12][13][14] and surgical revision of the bleb. 11,12,15 Medical treatment with aqueous humor suppressors has been shown to be successful in controlling the IOP immediately after the development of an EB. [11][12][13]15 Some have reported disappointing results when needling is performed without adjunct antimetabolites, 10,12 whereas others have observed success rates of up to 87.5% when transconjunctival needling is associated with 5-fluouracil (5-FU) or mitomycin-C (MMC).…”

Section: Introductionmentioning

confidence: 99%

“…11,12,15 Medical treatment with aqueous humor suppressors has been shown to be successful in controlling the IOP immediately after the development of an EB. [11][12][13]15 Some have reported disappointing results when needling is performed without adjunct antimetabolites, 10,12 whereas others have observed success rates of up to 87.5% when transconjunctival needling is associated with 5-fluouracil (5-FU) or mitomycin-C (MMC). [16][17][18][19] However, the long-term follow-up of patients developing EBs has not been sufficiently investigated.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Long-term intraocular pressure control of eyes that developed encapsulated blebs following trabeculectomy

Costa

Arcieri

Freitas

2005

Eye

View full text Add to dashboard Cite

Purpose To evaluate the long-term intraocular pressure (IOP) control of eyes that developed an encapsulated bleb (EB) following trabeculectomy. Methods Between 1994 and 1995, 25 eyes developed EBs and were randomized to medical treatment or needling without adjunct antimetabolites. Among the 25 patients who developed an EB, 21 were followed for at least 6 months. A control group of 21 consecutive eyes, which underwent trabeculectomy during the same period and that did not develop EBs was retrospectively selected. Success was defined as IOP o21 mmHg with or without medications. Kaplan-Meier survival analysis was performed to compare the groups. Results Among the 21 eyes that developed EBs, 12 (57%) had undergone transconjunctival needling and nine (43%) had received medical treatment. Mean follow-ups were 30.0714.0 months, 33.3718.5 months, and 37.472.6 months for the needling, medical treatment, and control groups, respectively (P ¼ 0.19). Kaplan-Meier survival curves demonstrated that the control group showed a significantly lower chance of failure than both the needling and the medical treatment groups (Po0.0001). Conclusion Encapsulated blebs may be associated with an increased risk for surgical failure.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Long-term intraocular pressure control of eyes that developed encapsulated blebs following trabeculectomy

Costa

Arcieri

Freitas

2005

Eye

View full text Add to dashboard Cite

show abstract

Corneal Endothelial Toxic Effect Secondary to Fluorouracil Needle Bleb Revision

Chalfin

Memmen

1995

Arch Ophthalmol

View full text Add to dashboard Cite

Nd:YAG Laser Goniopuncture for Late Bleb Failure After Trabeculectomy With Adjunctive Mitomycin C

Susanna

Moraes²,

Alencar

et al. 2014

JAMA Ophthalmol

View full text Add to dashboard Cite

IMPORTANCEThere is an increasing need to prolong trabeculectomy success rates with minimally invasive procedures.OBJECTIVE To investigate the safety and efficacy of Nd:YAG laser goniopuncture (LGP) in lowering intraocular pressure (IOP) in eyes having late bleb failure following trabeculectomy with mitomycin C administration. DESIGN, SETTING, AND PARTICIPANTS Prospective, noncomparative, interventional cohort at a referral glaucoma practice, including 19 eyes of 19 patients with uncontrolled glaucoma after failed trabeculectomy.INTERVENTIONS All eyes had ischemic nonfunctioning blebs with patent internal ostia and underwent Nd:YAG LGP, followed by a 5-fluorouracil injection. MAIN OUTCOMES AND MEASURESThe IOP and the number of antiglaucoma medications before and after the procedure, as well as presurgical and postsurgical appearance of the blebs, using the Indiana Bleb Appearance Grading Scale classification. RESULTSThe mean (SD) time of LGP after trabeculectomy was 35.7 (32.3) months, and the mean (SD) follow-up period after LGP was 6.0 (1.1) months (range, 4.4-8.4 months). The mean (SD) IOP had decreased from 20.9 (4.5) mm Hg (range, 15.5-29.0 mm Hg) to 11.9 (4.1) mm Hg (range, 5.0-21.0 mm Hg) (P < .001). The only complications observed after LGP were 2 cases of hypotony, which resolved spontaneously. Compared with baseline Indiana Bleb Appearance Grading Scale classifications, 2 eyes showed an increase in bleb height and 10 eyes showed an increase in bleb extension. None of the eyes had a positive Seidel test result. The mean (SD) number of hypotensive agents per eye had decreased from 0.7 (1.1) to 0.3 (0.7) after the procedure. At the last follow-up visit, 15 eyes (79%) had achieved an IOP of 15 mm Hg or less, with a minimum IOP reduction of 20% from baseline without medication use. CONCLUSIONS AND RELEVANCEThe Nd:YAG LGP is a safe and effective procedure for lowering IOP in eyes with ischemic nonfunctioning blebs and patent trabeculectomy ostia. This is a promising solution to rescue failed trabeculectomies and can potentially prolong trabeculectomy success rates.

show abstract

Needle Revision With and Without 5-Fluorouracil for the Treatment of Failed Filtering Blebs

Cited by 105 publications

References 12 publications

Long-term intraocular pressure control of eyes that developed encapsulated blebs following trabeculectomy

Long-term intraocular pressure control of eyes that developed encapsulated blebs following trabeculectomy

Corneal Endothelial Toxic Effect Secondary to Fluorouracil Needle Bleb Revision

Nd:YAG Laser Goniopuncture for Late Bleb Failure After Trabeculectomy With Adjunctive Mitomycin C

Contact Info

Product

Resources

About