Needling Revision of Trabeculectomies

Rotchford, Alan P; King, Anthony J

doi:10.1016/j.ophtha.2007.10.023

Cited by 72 publications

(41 citation statements)

References 17 publications

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“…[514] However, other authors have reported that the cumulative success rate of revision diminished over time to 13%–28% at 4 years. [15] These authors concluded that revision seems to be an effective form of intervention in the short- to medium-term, but that additional intervention was subsequently necessary in the majority of cases.…”

Section: Discussionmentioning

confidence: 99%

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Revision of trabeculectomy filtering blebs with mitomycin C: Long term results

Tulidowicz-Bielak

Kosior‐Jarecka

Żarnowski

2016

Indian J Ophthalmol

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Aim:The aim of the study is to assess the outcomes of transconjunctival mitomycin C (MMC)-augmented revision in eyes with failed trabeculectomy.Materials and Methods:This is a retrospective, noncomparative case series. One hundred and twenty-one eyes of 113 consecutive glaucoma patients with previously failed trabeculectomy who underwent transconjunctival revision with at least 12 months of follow-up were initially included in the study. The success was determined on the basis of intraocular pressure (IOP) alone. The main outcome measures were IOP, best-corrected distance visual acuity, complications, bleb appearance, lens status, visual field progression, and time between primary trabeculectomy and MMC revision. The main purpose of the study was to determine the efficacy of a single MMC-augmented needle revision.Results:Mean follow-up was 2.3 years. Twelve months after revision, IOP had declined from 26.1 ± 8.4 mmHg to 14.1 ± 4.8 mmHg (P < 0.05) and remained 16.0 ± 5.6 mmHg at 24 months, 15.7 ± 5.8 mmHg at 48 months, and 15.2 ± 4.0 mmHg at 60 months. Complete success was achieved in 53% of cases, 84% achieved qualified success, and 16% were classified as failures 12 months after revision. Early complications developed in 45 of the initial 121 eyes (37.2%).Conclusions:Transconjunctival MMC-augmented revision appears to be a safe and useful tool in reducing IOP and re-establishing filtration after trabeculectomy failure. This simple procedure has a high rate of success and helps avoid other surgical interventions which are more destructive for the conjunctiva.

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Section: Discussionmentioning

confidence: 99%

“…The type and rate of complications observed in our study were similar to those described by other authors. [1415] Most of these complications were early complications (hyphema, hypotony, and subconjunctival hemorrhage) which resolved spontaneously within a few days.…”

Section: Discussionmentioning

confidence: 99%

Revision of trabeculectomy filtering blebs with mitomycin C: Long term results

Tulidowicz-Bielak

Kosior‐Jarecka

Żarnowski

2016

Indian J Ophthalmol

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“…It is a safe and effective procedure by which a significant number of failed or failing filtration blebs can be rescued. Additional interventions are necessary in a proportion of cases [10]. It is generally accepted that needling of encapsulated blebs is more effective than needling of clinically non-cystic blebs.…”

Section: Discussionmentioning

confidence: 99%

Bleb Needling in Encapsulated Filtering Blebs: Evaluation by Optical Coherence Tomography

Guthoff

Hensler

et al. 2009

Ophthalmologica

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Purpose: To evaluate the role of anterior segment optical coherence tomography (OCT) in describing the morphology and outcome of encapsulated filtering blebs after bleb needling. Procedures: Prospective assessment of 9 patients – before, 2 days and 6 months after filtering bleb needling with 5-FU – using slit-lamp examination, Goldmann tonometry and OCT. Results: Before the needling, the average internal height of the cyst was 1.3 ± 0.8 mm. Two days after the needling procedure, the cyst collapsed in 5 patients. After 6 months, the average internal cyst height was 0.7 ± 0.4 mm. All patients with a collapsed cyst at day 2 after needling had controlled regulated IOP without glaucoma medication. Conclusions: The preoperative internal height of the cyst does not correlate with the outcome of the needling. A collapsed cyst at day 2 after needling is an indicator of controlled intraocular pressure, whereas a prominent cyst after 6 months indicates poor function.

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“…In most cases, a transconjunctival needling of the bleb is performed, in which the encapsulated bleb is opened and the aquous outflow is restored [7–9]. A dangerous complication of needling is the hypotonic shift [10, 11].…”

Section: Introductionmentioning

confidence: 99%

Revision of encapsulated blebs after trabeculectomy: Long-term comparison of standard bleb needling and modified needling procedure combined with transconjunctival scleral flap sutures

et al. 2017

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PurposeTo compare two surgical approaches for treating encapsulated blebs after trabeculectomy with mitomycin C, in terms of the development of intraocular pressure and progression of glaucoma in a long-term follow up: 1. bleb needling alone vs. 2. a combined approach of needling with additional transconjunctival scleral flap sutures, to prevent early ocular hypotony.MethodsForty-six patients with failing blebs after trabeculectomy with mitomycin C were enrolled in this study. Patients received either needling revision alone (group 1; n = 23) or a combined needling with additional transconjuctival flap sutures, if intraoperatively the intraocular pressure was estimated to be low (group 2; n = 23). Intraocular pressure (IOP), visual acuity, visual fields, and optic nerve head configuration by means of Heidelberg Retina Tomograph (HRT®) were analysed over time. Results from both groups were compared using Mann-Whitney U-test for single timepoints.ResultsIOP did not differ significantly between the two groups during follow-up at three months (P = 0.13), six months (P = 0.12), one year (P = 0.92) and two years (P = 0.57) after surgery. Furthermore, there was no significant difference in the course of glaucoma concerning the optic nerve anatomy between the two groups (Rim Area Change in the Moorfields Regression Analysis of HRT®) till two years after surgery (P = 0.289). No functional impairment in visual acuity and visual fields was found in the groups of the study.ConclusionsSingle needling procedure is a standard successful method for restoring the function of encapsulated blebs. Postoperative hypotony represents a possible hazard, which can be minimized by additional transconjunctival flap sutures. Long-term results suggest that this modification is equally effective in lowering the IOP and preventing the progression of glaucoma as the standard needling procedure. To our knowledge this is the first study to investigate the long-term effect of tranconjunctival sutures for the prevention of hypotony.

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Needling Revision of Trabeculectomies

Cited by 72 publications

References 17 publications

Revision of trabeculectomy filtering blebs with mitomycin C: Long term results

Revision of trabeculectomy filtering blebs with mitomycin C: Long term results

Bleb Needling in Encapsulated Filtering Blebs: Evaluation by Optical Coherence Tomography

Revision of encapsulated blebs after trabeculectomy: Long-term comparison of standard bleb needling and modified needling procedure combined with transconjunctival scleral flap sutures

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