Bleb needling outcomes for failed trabeculectomy blebs in Asian eyes: a 2 year follow up

Abstract

AbstractPurpose To describe the outcomes and success rates of bleb needling in primary angle closure glaucoma (PACG), primary open angle glaucoma (POAG) and secondary glaucoma.Methods Retrospective review of 270 patients who underwent bleb needling over a 2 year period. Complete success was defined as intraocular pressure (IOP) >= 6mmHg and =< 21mmHg, in absence of further surgery or use of antiglaucoma medication. Qualified success met the above criteria with or without use of antiglaucoma medications.Results 207 eyes completed the two year follow up. 84% was primary glaucomas and 16% was secondary glaucomas. The mean interval between filtering surgery and bleb needling was 8.4(SD 17.2) months. The mean IOP pre‐needling was 21 (SD7.2) and there was a statistically significant reduction of IOP of at least 22% from month 1 through to month 24. The complete success rates at month 6 for POAG, PACG and secondary glaucoma are 70%, 66% and 49% respectively, 62%, 62% and 51% at month 12, and 58%, 63% and 38% at month 24. The qualified success rates at month 6 for POAG, PACG and secondary glaucoma 24%, 30% and 29% respectively, 32%, 29% and 36% at month 12, and 35%, 30% and 53% at month 24. Logistic regression analysis showed that at month 6, POAG and PACG had a greater needling success compared to secondary glaucoma (OR 4.3.and 6.0 respectively; p < 0.05). However, at month 12 and 24 the difference in success rates was not statistically significant.Conclusion Bleb needling within one year of trabeculectomy in Asian eyes can provide clinically significant IOP lowering of >22% for 2 years. Eyes with primary glaucomas had a greater success. Asian eyes have a greater propensity for scarring but timely bleb needling can rescue bleb function.