This article is more than 5 years old. Information may no longer be current.
Modified bleb needling procedure can successfully lower IOP
The procedure may also prevent patients from undergoing other extensive glaucoma surgeries.
Click Here to Manage Email Alerts
A modified bleb needling procedure performed in the operating room can reduce or maintain a target IOP for patients with uncontrolled IOP, according to a study.
Needling of a scarred trabeculectomy bleb can prevent patients from undergoing further extensive surgical procedures, such as tube shunts, according to David S. Friedman, MD, PhD, a co-author of the study.
“When you get to the point where the bleb is failing, you are looking at bigger procedures like tube shunts and more invasive approaches. I observed a colleague in the U.K. using this technique and then decided to try it, and it worked right off the bat. It seemed worth trying, given that the alternative is a much more invasive procedure, and it has become a big part of my practice. The needling I prefer is in the operating room; doing it under the microscope instead of the slit lamp gives good control and provides immediate feedback. Because I infuse water into the eye under pressure while I am doing the procedure, I am able to visualize when I have broken through the scar tissue. This feedback helps to guide the procedure,” Friedman told Ocular Surgery News.
Needling reduces IOP
Friedman and colleagues included 33 eyes of 30 patients in the study, published in the Journal of Glaucoma. IOP reduction and number of glaucoma medications were recorded postoperatively at 1 day, 1 week, 1 month, 3 months, 6 months and 1 year.
The technique included the use of a 25-gauge infusion cannula in the anterior chamber. Fibrotic adhesions within the bleb were lysed with a 25-gauge needle, according to the study.
Postoperative IOP for patients who underwent the modified bleb needling procedure was significantly lower than baseline at all of the follow-up time points (P < .05). Patients experienced an overall IOP reduction of 30% at the 1-year follow-up time point.
The average IOP at last follow-up was 13.6 ± 5.3 mm Hg, and the average number of medications at last follow-up was 1.4 ± 1.5. Trabeculectomy surgery had been performed on average 5 years before needling.
“We used the procedure on blebs that were around for a long time, that had a fair amount of scarring. We were able to get good results at 1 year, and I was willing to try it on almost all patients, and that included some very flat-looking blebs. If you choose the ones that look optimal, you may be able to do better percentage wise,” Friedman said.
No serious complications
The cost of the procedure was minimal, Friedman said.
There were few complications within the study cohort, and none of them were major.
“This is a procedure that is worth trying. People will see that it helps avoid larger surgeries, and it has a pretty short learning curve. You get better at it quickly, and I think most patients are quite happy with the outcomes,” Friedman said. – by Robert Linnehan
- Reference:
- Wilson ME, et al. J Glaucoma. 2016;doi:10.1097/IJG.0000000000000511.
- For more information:
- David S. Friedman, MD, PhD, can be reached at Wilmer Eye Institute, Dana Center for Preventive Ophthalmology, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287; email: david.friedman@jhu.edu.
Disclosure: Friedman reports no relevant financial disclosures.