Needle revision with MMC revives blebs, controls IOP

Ophthalmology. 2011;118(4):755-762.

Needle revision with adjunctive mitomycin C is an effective treatment option for failed blebs during the late postoperative period, a study said.

"Needling is simple, relatively safe and fast compared with a major surgical procedure and has a high success rate, even in complicated glaucomas," the authors said.

The prospective interventional case series included 125 eyes of 98 patients with uncontrolled glaucoma. All eyes had at least one failed trabeculectomy, a flat filtering bleb and a patent internal ostium on gonioscopy. The average time between the trabeculectomy and needle revision was 5.3 years.

Researchers re-established aqueous flow and raised the bleb in 115 eyes (92%) after performing 186 needling procedures with subconjunctival injections of 8 µg of MMC. Of all the eyes, 73 were needled once, 44 were needled twice, seven were needled three times and one was needled four times.

Success was defined as having IOP of 16 mm Hg or less. After an average of 20.8 ± 12 months, mean IOP decreased from 20.1 ± 5.2 mm Hg to 13.2 ± 6.8 mm Hg (P < .001), the study said.

The mean number of hypotensive medications decreased from 2.4 ± 1.1 to 0.8 ÷ 1.3 (P < .001), making the overall success rate 76%, of which 58.4% were not on hypotensive medication and 17.6% were on medication.

Complications such as hyphemas and choroidal effusion were "minor, tolerable and transient" and did not require any treatment, the study said.