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Shah C, Sen P, Mohan A, Sen A, Sood D, Jain E. Outcome of Bleb Needling With 5-Fluorouracil in Failed Filtering Procedures in Pediatric Glaucoma. J Pediatr Ophthalmol Strabismus 2021; 58:118-125. [PMID: 34038270 DOI: 10.3928/01913913-20210105-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the surgical outcomes of bleb needling and the risk factors of failure of needling after failed filtration surgeries in patients with pediatric glaucoma. METHODS The medical records of patients who underwent needling with 5-fluorouracil following filtering surgeries (trabeculectomy, combined trabeculectomy, and trabeculotomy) between January 2012 and December 2016 were retrospectively reviewed. At the 1-year follow-up visit, complete success and qualified success were defined as an intraocular pressure (IOP) of less than 18 mm Hg with and without antiglaucoma medication, respectively. RESULTS Forty-five eyes that underwent needling and fulfilled the study criteria were included in the analysis. The mean age at needling was 9.6 years. The mean time interval between filtration surgery and the first needling procedure was 57.3 days. Thirty-eight of 45 eyes (84.4%) had undergone needling within 3 months after the primary surgery. Cumulative success was achieved in 35 eyes (77.7%) after needling (complete success in 22 eyes and qualified success in 13 eyes). Mean follow-up after needling was 18.9 months. The mean IOP before and after needling was 31.7 ± 9.45 and 16.6 ± 5.68 mm Hg, respectively (P < .00001). Steroid-induced glaucoma (P = .01), high IOP prior to the first filtration surgery (P = .01), and an inability to achieve low IOP (< 9 mm Hg, P = .04) immediately after needling were significant risk factors associated with failure. CONCLUSIONS Bleb needling is an efficient method for lowering IOP after a failed trabeculectomy or combined trabeculectomy and trabeculotomy in the pediatric population. [J Pediatr Ophthalmol Strabismus. 2021;58(2):118-125.].
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Comparison of Efficacy and Safety of Bleb Needle Revision With and Without 5-Fluorouracil for Failing Trabeculectomy Bleb. J Glaucoma 2020; 28:386-391. [PMID: 30839411 DOI: 10.1097/ijg.0000000000001226] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PRéCIS:: Bleb needle revision with and without 5-FU showed similar success rates over the course of a long-term follow-up. A greater total number of needle revisions was identified as a risk factor for procedural failure. PURPOSE The purpose of the study was to investigate the efficacy and safety of bleb needle revision with adjunctive 5-fluorouracil (5-FU) subconjunctival injection in large-scaled patients with failing trabeculectomy bleb. MATERIALS AND METHODS A retrospective chart review was performed on a total of 113 eyes of 106 subjects who had undergone trabeculectomy followed by needle revision and been followed up for at least 6 months. The subjects were divided into 2 groups according to whether they had also undergone concurrent adjunctive 5-FU subconjunctival injection. Two definitions of failure were derived irrespective of IOP-lowering medication use and were assessed at each follow-up visit: (1) IOP>21 mm Hg or >85% of preoperative IOP or reoperation for glaucoma, (2) IOP>18 mm Hg or >80% of preoperative IOP or reoperation for glaucoma. RESULTS A total of 78 eyes of 73 subjects underwent the simple needle revision procedure and 35 eyes of 33 subjects underwent needle revision with subconjunctival 5-FU injection. There was no significant adverse event for either group and no significant IOP difference in any of the observational periods between them (P=0.867). There was also no statistically significant difference in the total number of IOP-lowering medications between the groups (P=0.199). The success rate at 24 months after the first needle revision was 45.6% (95% CI: 33.7, 56.7) in simple revision group and 44.6% (95% CI: 27.7, 60.2) in 5-FU needle revision group by failure 1, 36.3% (95% CI: 25.4, 47.2) and 32.9% (95% CI: 18.0, 48.6) by failure 2, respectively. A greater total number of needle revisions was the significant risk factors for needle revision failure (HR=2.25 and P=0.001 according to failure 2). CONCLUSIONS Bleb needle revision with 5-FU subconjunctival injection is a safe procedure for failing trabeculectomy bleb. Bleb needle revision with and without 5-FU were equally likely to succeed.
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Lee YS, Wu SC, Tseng HJ, Wu WC, Chang SH. The relationship of bleb morphology and the outcome of needle revision with 5-fluorouracil in failing filtering bleb. Medicine (Baltimore) 2016; 95:e4546. [PMID: 27603345 PMCID: PMC5023867 DOI: 10.1097/md.0000000000004546] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To investigate the risk factors for failure of needling revision with 5-fluorouracil (5-FU) and to identify the correlation of outcomes of needling revision and the morphological features of dysfunctional filtration blebs using Moorfields bleb grading system.This retrospective, nonrandomized, comparative case-control study included 41 consecutive patients (41 eyes) who underwent 5-FU needling revision for failed or failing filtration blebs between July 2012 and August 2014 in Chang Gung Memorial Hospital, a referral center in Taiwan. The main outcome measures were the bleb survival and the correlation factors of bleb morphology before revision. The secondary outcome measure was the identification of any study factor associated with bleb failure.Forty-one eyes of 41 patients were included in this study. The most frequent glaucoma diagnoses were 10 cases (24%) of neovascular glaucoma and 8 cases (19%) of chronic open-angle glaucoma. Survival of bleb at 6, 12, and 24 months was 42%, 39%, and 23%. Fourteen cases (34%) maintained overall success at the last follow-up, with an average follow-up of 22.7 ± 9.4 months (range: 12-48 months). The central bleb area and height were significantly different between the successful needling group and the failed needling group (P = 0.03 and 0.04, respectively). Further trend test confirmed that smaller central bleb extension and flatter height were associated with a higher chance of failure (P = 0.02 and 0.02, respectively). Time from initial trabeculectomy to needling of less than 4 months and higher intraocular pressure (IOP) in the first postoperative week also led to significantly higher risk for failure (P = 0.01 and 0.03, respectively).A small central area and the flat height of dysfunctional blebs were more likely to fail after the needle revision. Cautious case selections, taking account of the time from the initial filtering surgery and postoperative IOP, may improve the surgical outcome.
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Affiliation(s)
- Yung-Sung Lee
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou
| | - Shiu-Chen Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou
- College of Medicine, Chang Gung University, Taoyuan
| | - Hsiao-Jung Tseng
- Biostatistical Center for Clinical Research, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou
- College of Medicine, Chang Gung University, Taoyuan
| | - Shirley H.L. Chang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou
- College of Medicine, Chang Gung University, Taoyuan
- Correspondence: Shirley H.L. Chang, Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan; No. 5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan (R.O.C.) (e-mail: )
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Abstract
PURPOSE To evaluate outcomes of trabeculectomy bleb needle revision with 5-fluorouracil augmentation performed in the operating theater. METHODS Retrospective study of all patients undergoing trabeculectomy bleb needle revisions in the operating theater performed by a single surgeon in a metropolitan hospital in Australia. A total of 51 needle revisions were performed on 33 eyes over a mean follow-up time of 1.81±1.56 years. RESULTS A total of 29% achieved intraocular pressure (IOP) ≤20 mm Hg off all glaucoma medications, and an additional 39% achieved qualified success with the addition of glaucoma medications, giving overall success of 68%. Analyzing success rate for target IOP≤16 mm Hg, 24% achieved target off all glaucoma medications, 35% achieved qualified success with the addition of glaucoma medications, giving an overall success rate of 59%. There was a statistically significant improvement in IOP, as compared with preoperative levels, at all timepoints postoperatively (P<0.05). However, number of glaucoma medications remained unchanged (P>0.05) contributing to the high percentage of qualified successes. Visual acuity remained unchanged and there were no major postoperative complications. The Kaplan-Meier survival shows a survival rate of 60% with IOP≤20 mm Hg and 40% for IOP≤16 mm Hg at 5 years. CONCLUSIONS Trabeculectomy needle revision is a useful option for the management of elevated IOP in the presence of a failed or failing trabeculectomy bleb. However, as with trabeculectomy, there tends to be a failure rate over time. This often leads to reinstitution of glaucoma medications and/or further needle revisions to maintain IOPs at target level. The procedure itself is minimally invasive with an acceptable safety profile.
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Abstract
PURPOSE The aim of this study is to evaluate the safety and efficacy of laser goniopuncture (LGP) to lower intraocular pressure (IOP) post-viscocanalostomy (VC)/phacoviscocanalostomy (PVC). Outcomes include: IOP reduction from pre-LGP levels and the need for further topical antiglaucomatous medication or surgery. PATIENTS AND METHODS A total of 541 eyes that underwent VC/PVC between 2009 and 2012, at the Stanley eye unit in Abergele were included in the study. INCLUSION CRITERIA All patients who had LGP at any timepoint after VC/PVC when target IOP was not achieved +/- progression in visual field with at least 6 months of follow-up data.Statistical analysis was performed on IOP values pre- and post-LGP, involving χ, Fischer exact, Mann-Whitney U, and Wilcoxon tests. A P-value of <0.05 was accepted as the level of significance. RESULTS Of the 515 included eyes, 136 (26%) required LGP after a mean of 15.11±9.73 months after surgery (95% confidence interval, 13.46-16.76 mo), ranging from 1 to 42 months. LGP reduced IOP significantly from a mean of 22.92±5.80 to 17.08±5.30 mm Hg immediately for all eyes, a reduction of 5.84 mm Hg (or a 25% reduction) (P<0.0001). IOP significantly reduced in the VC group with a mean reduction of 7.60 mm Hg compared with 4.85 mm Hg in the PVC group immediately after the procedure (P=0.0038). LGP was required sooner in the VC group compared with PVC, 11.35 and 14.57 months, respectively (P=0.0393). A total of 69 (62%) eyes were commenced on topical IOP-lowering medications, mean 7.26±6.41 months after LGP. CONCLUSIONS This study supports previous evidence that LGP enhances the IOP-lowering success of VC/PVC. The advantages of LGP are that it is a minimally invasive clinic-based procedure with a low complication rate.
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Amini H, Esmaili A, Zarei R, Amini N, Daneshvar R. Office-based slit-lamp needle revision with adjunctive mitomycin-C for late failed or encapsulated filtering blebs. Middle East Afr J Ophthalmol 2013; 19:216-21. [PMID: 22623862 PMCID: PMC3353671 DOI: 10.4103/0974-9233.95255] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: The purpose of this study was to assess the results of bleb needling in glaucomatous patients with late failed filtering blebs. Materials and Methods: A retrospective case series of 27 eyes of 27 patients was considered. All patients underwent needle bleb revision with adjuvant mitomycin-C performed at the slit lamp, during an office visit. Complete success was defined as postneedling intraocular pressure (IOP) ≤ 21 mmHg without any antiglaucoma medications and qualified success was IOP ≤ 21 mmHg with topical antiglaucoma medications. Results: There were 12 eyes with encapsulated blebs and 15 eyes with flat blebs. The mean interval between index filtering surgery and bleb revision was 32.74 ± 15.36 months. Mean IOP was 25.07 ± 4.80 mmHg before surgery and 19.66 ± 4.97 mmHg at last postoperative follow-up. The mean follow-up was 20.31 ± 15.63 months. Complete and qualified successes were 7.4% and 51.9%, respectively. Cumulative rates of success at 1, 2, 3, and 4 years were 76%, 65%, 49%, and 37%, respectively. The mean number of antiglaucoma medications was reduced from 3.15 ± 0.36 preoperatively to 2.33 ± 1.21 postoperatively (P<0.001). Conclusion: Slit-lamp needle revision in office is a simple and effective method for treating late encapsulated or flat filtering blebs without significant complications even for late bleb failure.
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Affiliation(s)
- Heidar Amini
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Simsek T, Cankaya AB, Elgin U. Comparison of needle revision with subconjunctival bevacizumab and 5-fluorouracil injection of failed trabeculectomy blebs. J Ocul Pharmacol Ther 2012; 28:542-6. [PMID: 22731246 DOI: 10.1089/jop.2012.0035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
PURPOSE To evaluate the efficacy and complications of bevacizumab versus 5-fluorouracil (5-FU)-augmented bleb needling of failed filtration blebs following trabeculectomy. METHODS Twenty-seven eyes of 27 patients with bleb failure were included. Patients were randomly assigned to receive either 5-FU or bevacizumab. Needling was performed in the operating room under sterile conditions. After the needling procedure, a viscoelastic material was injected subconjunctivally around the bleb area to avoid the entrance of 5-FU or bevacizumab into the anterior chamber. Bevacizumab (1.25 mg/0.1 mL) was injected into 12 eyes and 5-FU injected into 15 eyes subconjunctivally. All of the patients were controlled weekly until a filtration bleb was maintained. Intraocular pressure (IOP), bleb appearance, and complications were noted in each group. Success was defined as absolute if the IOP 21 mmHg or less without any medication or surgical intervention at last visit, and qualified if the IOP 21 mmHg or less with topical antiglaucomatous medications. The patients were followed from 11 to 26 (median, 17) months. RESULTS The IOP decreased, from 31.2±3.2 mmHg to 16.1±2.1 mmHg, in the bevacizumab group on the first postoperative day. The IOP was within normal limits in 1 (8.3%) patient without medication and controlled with topical antiglaucomatous drops in 2 (16.7%) patients. The total success rate was 25% at the time of the last visit. Success was not achieved in 9 (75%) eyes. The IOP was 32.0±4.6 mmHg preoperatively and 12.2±2.6 mmHg on the first postoperative day in the 5-FU injected patients. The total success rate was 80%; 8 (53.3%) eyes showed absolute success, whereas 4 (26.7%) eyes showed a qualified success. A statistically significant difference between groups in terms of success rates was observed (P=0.04). CONCLUSIONS Subconjunctival 5-FU application is a more effective therapy than bevacizumab application for needling procedures in failed trabeculectomy blebs.
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Affiliation(s)
- Tulay Simsek
- Glaucoma Division, Ulucanlar Training and Research Eye Hospital, Ankara, Turkey.
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Maestrini HA, Cronemberger S, Matoso HDS, Reis JRC, Mérula RV, Filho AD, Diniz AF, Sakurai E, Ferreira GA. Late needling of flat filtering blebs with adjunctive mitomycin C: efficacy and safety for the corneal endothelium. Ophthalmology 2010; 118:755-62. [PMID: 21055818 DOI: 10.1016/j.ophtha.2010.08.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 08/06/2010] [Accepted: 08/11/2010] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To assess the efficacy of needle revision using mitomycin C (MMC) for reviving failed filtering blebs during the late postoperative period and its safety for the corneal endothelium. DESIGN Prospective interventional case series. PARTICIPANTS We recruited 125 eyes from 98 patients with uncontrolled glaucoma. All had at least 1 failed trabeculectomy, a flat filtering bleb, and a patent internal ostium on gonioscopy. The average time between the last trabeculectomy and needle revision was 5.3±5.3 years (range, 6 months to 30 years). INTERVENTION Needling revision with a subconjunctival injection of 8 μg of MMC. MAIN OUTCOME MEASURES Intraocular pressure (IOP) and number of hypotensive medications at latest visit, central corneal thickness (CCT), corneal endothelial cell density (ECD), coefficient of variation of cell size (CV), and hexagonality before and after needling. RESULTS We performed 186 needling procedures on 125 eyes (mean, 1.5±0.6 procedures/eye). Seventy-three eyes (58.4%) were needled once, 44 eyes (35.2%) were needled twice, 7 eyes (5.6%) were needled 3 times, and 1 eye (0.8%) was needled 4 times. We reestablished aqueous flow and obtained a raised bleb in 115 eyes (92%). After an average follow-up of 20.8±12.0 months, the mean IOP decreased from 20.1±5.2 mmHg preoperatively to 13.2±6.8 mmHg (P<0.001), and the mean number of hypotensive medications per eye decreased from 2.4±1.1 to 0.8±1.3 (P<0.001) at the latest visit. The overall success rate (IOP ≤16 mmHg) was 76% (58.4% without medication and 17.6% with hypotensive medications). Kaplan-Meier survival rates were 91.2% at the 1-month follow-up, 84.5% at 6 months, 81.0% at 1 year, 74.6% at 2 years, and 66.3% at 3 years. We studied the corneal endothelium in 42 eyes of 36 patients. There was no statistically significant difference between preoperative CCT, ECD, CV, or hexagonality and postoperative measurements at 1 week and 1, 3, 6, and 12 months. CONCLUSIONS Needling revision with adjunctive MMC is effective for reviving flat filtering blebs and controlling IOP, even several years after the original trabeculectomy, and seems to be safe for the corneal endothelium.
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Affiliation(s)
- Heloisa A Maestrini
- Department of Ophthalmology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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Long-term outcomes of needle revision of trabeculectomy blebs with mitomycin C and 5-fluorouracil: a comparative safety and efficacy report. J Glaucoma 2009; 18:513-20. [PMID: 19223788 DOI: 10.1097/ijg.0b013e3181911271] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the long-term comparative outcomes for needle revision with 5-fluorouracil (5-FU) and mitomycin C (MMC) of failed trabeculectomy blebs. PATIENTS AND METHODS A retrospective database search was made for all patients who had needle revision with subconjunctival antimetabolite injections on the slit lamp from August 2001 to April 2006. Needle revisions were augmented with MMC instead of 5-FU from December 2003. Ninety-eight eyes of 95 consecutive patients (45 with MMC and 53 with 5-FU) with a minimum follow-up of 1 year were included. 5-FU (5 mg) or MMC (0.02 mg), with 0.1 mL of 2% lignocaine was injected subconjunctivally at least 10 minutes before the revision procedure in the clinic. No patient from the MMC group received subsequent 5-FU injections. RESULTS The 5-FU group had significantly longer mean follow-ups (P<0.001) of 53.0+/-18.12 months compared with 33.3+/-9.0 months in the MMC group. The 5-FU group had a significantly higher number of needle revisions than MMC group (1.9+/-1.0 vs. 1.2+/-0.5, P=0.001). Twenty-five eyes (47%) of the 5-FU group and 36 eyes (80%) of the MMC group had a single needle revision (P=0.009). The probability of maintaining intraocular pressure between 5 and 16 mm Hg with no glaucoma medication or further surgical procedure was 71% (62%-88%) and 45% (33%-60%) at 1 year and 61% (49%-78%) and 30% (20%-46%) at 2 years in the MMC and 5-FU groups, respectively. MMC use (hazard ratio=2.18, 95% confidence interval, 1.25-3.81, P=0.006) and intraocular pressure drop immediately after needling as a continuous variable (hazard ratio=1.06, 95% confidence interval, 1.00-1.13.8, P=0.03) were significantly associated with success. Twelve eyes (22.6%) with failed 5-FU needling had subsequent MMC needle revisions, 5 of which were successful by the study criterion. Eyes with 5-FU needle revision were more likely to fail within the first 6 months (P=0.02). Serious complications included blebitis in 3 (5.7%) and 1 (2.2%), delayed bleb leaks in 9 (17.0%) and 1 (2.2%) eyes in the 5-FU and MMC groups, respectively. There was no statistical difference in the complication rates between the groups. Aqueous misdirection was observed in 1 (2.2%) eye of MMC group and delayed suprachoroidal hemorrhage in 1 (1.9%) eye of 5-FU group. CONCLUSIONS This study suggests that MMC is more effective than 5-FU for needle revision of failed trabeculectomy blebs.
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Rotchford AP, King AJ. Needling Revision of Trabeculectomies. Ophthalmology 2008; 115:1148-1153.e4. [PMID: 18082890 DOI: 10.1016/j.ophtha.2007.10.023] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2007] [Revised: 10/04/2007] [Accepted: 10/16/2007] [Indexed: 10/22/2022] Open
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Cannon PS, Spencer AF, Lavin M. Good functional recovery following intervention for delayed suprachoroidal haemorrhage post bleb needling: a case report. J Med Case Rep 2008; 2:81. [PMID: 18339199 PMCID: PMC2276504 DOI: 10.1186/1752-1947-2-81] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Accepted: 03/13/2008] [Indexed: 11/15/2022] Open
Abstract
Introduction Bleb needling is a recognised procedure in the management of patients with failing trabeculectomies. Suprachoroidal haemorrhage can occur as an unusual complication. We report a pseudophakic man who had early surgical intervention for this complication. This intervention may have contributed to the good recovery of his visual acuity and the minimum changes to his visual fields. Case presentation A 79-year-old pseudophakic man with chronic open angle glaucoma presented with further deterioration of his right visual field despite maximum medical therapy and a previous trabeculectomy. The right visual acuity was 6/9 with an intraocular pressure (IOP) of 16 mmHg. Bleb needling with 5-fluouracil was performed in a standard manner. His postoperative IOP was 6 mmHg. Thirty-six hours later the visual acuity was reduced to hand movements and two large choroidal detachments where observed clinically, which progressed to suprachoroidal haemorrhages. Five days after the initial needling, the patient had complex surgery involving anterior chamber reformation, a bleb compression suture and drainage of the haemorrhagic suprachoroidal detachments. Subsequently, the patient had a right vitrectomy with endolaser following a vitreous haemorrhage. The final visual acuity was 6/9 with an intraocular pressure of 8 mmHg on travoprost and brinzolamide. The final visual field showed little change when compared with the pre-suprachoroidal haemorrhage visual field. Conclusion It is important to consider the possibility of delayed suprachoroidal haemorrhage as a complication in bleb needling, and early surgical intervention may be beneficial.
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Affiliation(s)
- Paul S Cannon
- Manchester Royal Eye Hospital, Oxford Road, Manchester, UK.
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Müller M, Pape S, Kusserow C, Hoerauf H, Laqua H. [Late needling with 5-fluorouracil when scarring of filtering bleb seems imminent]. Ophthalmologe 2007; 104:305-10. [PMID: 17372740 DOI: 10.1007/s00347-007-1497-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Evaluation of needling and 5-fluorouracil (5-FU) injections more than 4 months after preceding filtration surgery. PATIENTS AND METHOD Retrospective analysis of 17 eyes in 14 patients who underwent needling of the filtering bleb and administration of 5-FU by injection at least 4 months after trabeculectomy (TE) with mitomycin C (MMC; same surgeon throughout). Complete success was defined as a reduction of intraocular pressure (IOP) by >30% from the baseline value without further medication and, in cases of primary open-angle glaucoma, IOP of 18 mmHg. The mean period of follow-up was 8.1 months (3-24 months). RESULTS One to four needlings (Ø 1.6) with one to five injections (Ø 3.1) of 5-FU were performed as required according to clinical need an average of 31.3 months (4-108 m) after TE. The mean baseline IOP was 25 mmHg (+/-SD 6.02; median 25 mmHg). After needling and 5-FU injection the mean IOD at the last hospital visit was 13.64 mmHg (+/-SD 5.2, median 13 mmHg; p<0,001). Complete success was achieved in 82.4% of these cases. The mean reduction in IOP was 11.2 mmHg (0-22 mmHg). In the cases with successful outcome (14 of 17 eyes) the mean IOP reduction from baseline was 55%. Three eyes required further treatment. Complications encountered were hyphaema (2 cases), subconjunctival bleeding (1 case) and corneal erosion (3 cases). CONCLUSION Late needling and injections of 5-FU can restore filtering bleb function even over 4 months after initial surgery. The high success rate and low incidence of complications together with the simple procedure justify regarding this approach as an alternative that can be used before passing on to more invasive interventions.
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Affiliation(s)
- M Müller
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein,Campus Lübeck, Lübeck, Deutschland.
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Abstract
PURPOSE To present a case of a unilateral diffuse retinal hemorrhage in a 15-year-old girl, who underwent bilateral trabeculectomy for steroid induced glaucoma. METHODS Despite the maximally tolerable medical treatment, IOP in the right eye remained above 50 mmHg for four months, and was simultaneously elevated in the left eye. So we performed bilateral trabeculectomy. RESULTS On the first postoperative day, diffuse retinal hemorrhages were observed in the right eye; however, no retinal hemorrhage was found in the left eye. The hemorrhages resolved completely without consequences two months later. CONCLUSIONS In the case of high IOP for a long period, sudden lowering of IOP may acutely increase the blood flow and consequently rupture multiple retinal capillaries because of altered autoregulatory function. Special care is therefore needed to prevent an abrupt fall in IOP before, during, and after surgery, especially when IOP has been highly elevated for an extended period.
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Affiliation(s)
- Seung-Youn Jea
- Department of Ophthalmology, College of Medicine, Pusan National University, Pusan, Korea.
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Alwitry A, King AJ, Vernon SA. Successful combined cataract surgery and drainage of a needling-induced chronic ciliochoroidal detachment. Eye (Lond) 2004; 19:478-80. [PMID: 15297859 DOI: 10.1038/sj.eye.6701504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Syam PP, Hussain B, Anand N. Delayed suprachoroidal hemorrhage after needle revision of trabeculectomy bleb in a patient with hairy cell leukemia. Am J Ophthalmol 2003; 136:1155-7. [PMID: 14644230 DOI: 10.1016/s0002-9394(03)00574-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE To report a rare complication, delayed suprachoroidal hemorrhage, of needle revision of a nonfunctioning trabeculectomy bleb in a patient with previously undetected hairy cell leukemia. DESIGN Interventional case report. METHODS; An 89-year-old man presented with massive delayed suprachoroidal hemorrhage after needle revision of a trabeculectomy bleb. RESULTS Routine investigations before choriodal drainage showed a low platelet count. Anterior chamber washout and choroidal drainage were done after intravenous platelet infusions. Subsequently, the diagnosis of hairy cell leukemia was made by the hematologist. CONCLUSIONS Delayed suprachoroidal hemorrhage is a rare but devastating complication of needle revision of trabeculectomy blebs and should be borne in mind while performing this seemingly trivial outpatient procedure.
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Affiliation(s)
- Padmanabha Pillai Syam
- Department of Ophthalmology, Calderdale and Huddersfield National Health Service Trust, Huddersfield Royal Infirmary, Lindley, Huddersfield, United Kingdom
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Durak I, Ozbek Z, Yaman A, Soylev M, Cingil G. The role of needle revision and 5-fluorouracil application over the filtration site in the management of bleb failure after trabeculectomy: a prospective study. Doc Ophthalmol 2003; 106:189-93. [PMID: 12678284 DOI: 10.1023/a:1022550125261] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Fifty-three eyes of 49 consecutive patients with an intraocular pressure (IOP) over 21 mmHg; without bleb or with a thick, flat bleb after the second postoperative week following trabeculectomy were included in the study. Needle revision was performed with a 26-gauge tuberculin syringe containing 5 mg (0.2 ml) 5-FU in a period of 2 weeks to 10 months postoperatively after unsuccessful digital massage and/or laser suture-lysis. 5-FU injection was not performed when a bleb formation was observed during needling. In case of no bleb formation, 5-FU was injected subconjunctivally over the scleral flap area and repeated a maximum of six times until a functioning bleb was maintained. Needle revision was successful in 14 of 53 eyes (26.4%) as an initial procedure and nine (16.9%) eyes maintained success. Forty-four eyes (83.1%) had 5-FU injection since needle revision did not provide bleb formation (39 eyes) or did not maintain initial success (five eyes). Mean IOP was 27.8+/-4.7 mmHg (range, 22-41) before any intervention and decreased to 20.5+/-4.8 mmHg (range, 8-35) after a mean follow-up of 25.1 months and the difference was statistically significant (p<0.001). Mean IOP after needle revision in 14 patients was 18.9+/-4.9 mmHg (range, 8-29) and 16.3+/-3.7 mmHg in nine out of 14 patients that maintained success. Mean IOP after the last 5-FU injection was 21.4+/-4.6 mmHg (range, 13 to approximately 35 mmHg). The mean number of 5-FU injections was 2.4 (range, 1-6). During a mean follow-up of 25.1 months (range, 1-48 months), three eyes (5.7%) had diffuse corneal punctate epitheliopathy lasting for 3-4 weeks and subconjunctival hemorrhage was seen in nine eyes (17%). Needle revision and/or subconjunctival injection of 5-FU over the bleb area is a safe, relatively efficient approach with a low rate of complications to overcome the early and mid term bleb failure after trabeculectomy.
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Affiliation(s)
- Ismet Durak
- Department of Ophthalmology, Dokuz Eylül University School of Medicine, Izmir, Turkey.
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