The Efficacy of 5-Fluorouracil Bleb Needling Performed 1 Year or More Posttrabeculectomy

Kapasi, Mustafa; Birt, Catherine M.

doi:10.1097/ijg.0b013e318170a71c

Cited by 36 publications

(28 citation statements)

References 8 publications

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“…If we also consider patients who maintained an adaequate IOP with IOP lowering medication, this percentage increased to 78% (qualified success). The results of the single needling procedure as performed in our department are in overall agreement with those of other retrospective studies of bleb revisions (50% to 80%) [7–9, 17]. …”

Section: Discussionsupporting

confidence: 89%

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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Section: Discussionsupporting

confidence: 89%

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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“…Several studies have demonstrated the efficacy of needling revision in failing filtering blebs after filtration surgery (1-4,6,12,13,16-21). However, as bleb morphology, time of needling, follow-up period and successful criteria are different in each study, comparisons of these studies would not be meaningful.…”

Section: Discussionmentioning

confidence: 99%

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

Suzuki¹,

Susanna-Jr²

2013

Clinics

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OBJECTIVE:To compare the efficacy of transconjunctival needling revision with 5-fluorouracil versus medical treatment in glaucomatous eyes with uncontrolled intraocular pressure due to encapsulated bleb after trabeculectomy.METHODS:Prospective, randomized, interventional study. A total of 40 eyes in 39 patients with elevated intraocular pressure and encapsulated blebs diagnosed at a maximum five months after primary trabeculectomy with mitomycin C were included. The eyes were randomized to either transconjunctival needling revision with 5- fluorouracil or medical treatment (hypotensive eyedrops). A maximum of two transconjunctival needling revisions per patient was allowed in the needling arm. All patients underwent follow-up for 12 months. Successful treatment was defined as an intraocular pressure ≤ 18 mmHg and a 20% reduction from baseline at the final follow-up. Clinicaltrial.gov: NCT01887223.RESULTS:Mean intraocular pressure at the final 12-month follow-up was lower in the transconjunctival needling revision group compared to the medical treatment group. Similar numbers of eyes reached the criteria for treatment success in both the transconjunctival needling revision group and the medical treatment group.CONCLUSIONS:Despite similar success rates in eyes randomized to transconjunctival needling revision with 5-fluorouracil compared to eyes receiving medical treatment, there was a significantly lower mean intraocular pressure at 12 months after transconjunctival needling revision.

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“…19 Kapasi ve ark. 21 ilk cerrahi ile iğneleme arasındaki zamanın başarıyı etkilemediğini, revizyon cerrahisi öncesinde daha az sayıda ilaç alan olgularda başarının daha yüksek olduğunu ifade etmişlerdir. Çalışmamızda iğneleme yapılan 7 olguda başarı oranımız %57,1 olup önceki çalışmalara oranla daha düşüktü.…”

Section: Discussionunclassified

Trabekülektomi Sonrasında Bleb Yetmezliği Gelişen Olgularda Revizyon Cerrahisi Sonuçları

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et al. 2012

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Re sults: Sixteen cases were successfully treated, while 2 cases had this success with medication and 7 were unsuccessful with revision surgeries. The decrease in the IOP values was statistically significant in all visits after the surgeries (p<0.05). Four of 7 needling cases were successfully treated and 3 were unsuccessful. Four of 7 cases which had undergone bleb revision surgery were successful, whereas 3 were unsuccessful. Seven of 8 cases which had undergone repeat trabeculectomy were successful and 1 was unsuccessful. One case got the target IOP with antiglaucomatous medication after scleral suture removal. Dis cus si on: Despite the high success rates of trabeculectomy performed to decrease IOP which is the main risk factor in glaucoma, it is possible to get unsuccessful results because of the early or late bleb failure. Several revision surgery techniques were defined to manage these situations. The success rates of these techniques were not as high as the primary surgeries, but they can maintain structural and functional improvement. However, large series especially comparing the success rates of surgical techniques are needed. (Turk J Ophthalmol 2012; 42: 207-10)

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The Efficacy of 5-Fluorouracil Bleb Needling Performed 1 Year or More Posttrabeculectomy

Abstract: Late 5FU needling is an effective method to control IOP and avoid further surgery in a high proportion of patients with medically uncontrolled nonfiltering blebs.

Cited by 36 publications

References 8 publications

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

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

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

Trabekülektomi Sonrasında Bleb Yetmezliği Gelişen Olgularda Revizyon Cerrahisi Sonuçları

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