Bleb needling with subconjunctival injection of sodium hyaluronate 1.4%: 1-year outcomes

Abstract

Objectives To assess the safety and efficacy of 5-fluorouracil (5-FU)-augmented bleb needling revision (BNR) with subconjunctival Healon GV (sodium hyaluronate 1.4%) over a 12-month follow-up. Design Retrospective consecutive case series. Participants We studied 54 patients who had undergone primary BNR with adjunctive 5-FU and routine subconjunctival Healon GV between 2004 and 2007. Methods BNR was performed using multiple puncturing motions through the bleb: a 0.4 mL Healon GV injection between the bleb and conjunctiva; and a 5-FU (10 mg in 0.4 mL) injection into the substance of Healon GV. Success was defined as follows: (1) complete success, indicating intraocular pressure (IOP) reduction ≥ 20% and to ≤ 21 mm Hg but > 5 mm Hg without antiglaucoma medication; or (2) qualified success, indicating IOP reduction ≥ 20% and to ≤ 21 mm Hg but > 5 mm Hg with or without antiglaucoma medication. Patients requiring additional filtration surgery during the 12-month follow-up period were considered failures. Results Data collection was completed for 53 eyes of 46 patients. The IOP fell from a preoperative mean of 22.7 ± 7.95 mm Hg to 16.3 ± 4.34 mm Hg at 12 months ( p < 0.001). The complete success rate was 26.4%; the qualified success rate was 43.4%. Of the eyes studied, 28 (52.8%) achieved IOPs of ≤ 16 mm Hg at 12 months. Complications occurred in 16 eyes (30%), and 3 required surgical intervention. Conclusions Subconjunctival Healon GV in 5-FU-augmented bleb needling revision is a relatively safe and effective technique for reducing IOP in the short to medium term, and it involves few significant complications.