Abstract
Background. To compare the efficacy of needle revision with 5-fluorouracil (5-FU) and mitomycin C (MMC) on dysfunctional filtration blebs shortly after trabeculectomy. Methods. It is a prospective randomized study comparing needle revision augmented with MMC or 5-FU for failed trabeculectomy blebs. Results. To date 71 patients (75 eyes) have been enrolled, 40 eyes in the MMC group and 35 in the 5-FU group. 68 patients (72 eyes) have completed 12-month follow-up, 38 eyes in the MMC group and 34 in the 5-FU group. The mean IOP before and that after needle revision in the MMC group were 26.5 ± 4.3 mmHg and 11.3 ± 3.4 mmHg, respectively (P < 0.05), and in the 5-FU group were 27.1 ± 3.8 mmHg and 10.9 ± 3.4 mmHg, respectively (P < 0.05). At 12-month follow-up, complete success rates were 57.5% for MMC group and 34.3% for 5-FU group (P = 0.042; log-rank test) and 75% and 60% (P = 0.145; log-rank test), respectively, for the qualified success. Complication rates between the two groups were not statistically different (P > 0.05). Conclusions. Needle revision and subconjunctival MMC injection were more effective than needling and subconjunctival 5-FU injection for early dysfunctional filtration blebs after trabeculectomies.
Highlights
To compare the efficacy of needle revision with 5-fluorouracil (5-FU) and mitomycin C (MMC) on dysfunctional filtration blebs shortly after trabeculectomy
Failure of the filtration bleb due to subconjunctival scar formation can constitute a significant problem in achieving satisfactory intraocular pressure (IOP) control after trabeculectomy
The success rates with both compounds have been highly variable, ranging from 39% to 91% [8, 9, 12, 13, 16] at 12-month follow-up. This is consistent with our Complications Hypotony Corneal punctate epitheliopathy Anterior chamber reaction Subconjunctival hemorrhage Shallow anterior chamber Leak through conjunctival entry site
Summary
To compare the efficacy of needle revision with 5-fluorouracil (5-FU) and mitomycin C (MMC) on dysfunctional filtration blebs shortly after trabeculectomy. It is a prospective randomized study comparing needle revision augmented with MMC or 5-FU for failed trabeculectomy blebs. It is difficult to make a literature comparison between 5FU and MMC needle revisions because few reports have been published [15, 16] and those available mainly studied late bleb failure following trabeculectomy. To the best of our knowledge, this is the first study to directly compare needle revision with 5-FU and with MMC for failed filtration blebs shortly after trabeculectomy
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