Effectiveness of Needling Revision with Mitomycin-C for Failing Blebs

Sylvia L Groth,William Eric Sponsel

doi:10.4172/2155-9570.s4-006

Abstract

This surgical technique study was designed to evaluate the efficacy of surgical needling revision using Mitomycin-C to restore filtering function in scarred or encapsulated filtering blebs, and thereby minimize reliance on adjunctive medications. Twenty-eight eyes of 23 consecutive patients were studied, all having undergone operating room based bleb revisions for inadequate IOP-control during 2008-10. The standard needling procedure was performed as described with our previous data set, now using a 1-minute intra-bleb cannulation of 0.6 ml of 0.4 mg/ml MMC rather than multiple postoperative subconjunctival 5-fluorouracil injections. Outcome measures were IOP, number of antiglaucoma medications, and acuity. Both mean IOP reduction and decrease in anti-glaucoma medications at all four measured time intervals (1 week, 1 month, 2 months, 6 months) post-operatively were highly significant (p<0.0001). IOP was reduced from a mean of 27.2 ± 10.6 mmHg pre-op to 15 ± 7.8 mmHg 6 months post-op (Δ -45%), with 86% of eyes requiring glaucoma medication prior to the procedure and only 16% thereafter. At six months, 60% of eyes had IOP ≤15 mmHg without medications, and 76% ≤18 mmHg. Visual acuity was stable or improved in 69% of cases. Mitomycin-C augmented needling revision appears to be a reasonably safe and reliable option for restoring bleb function in glaucomatous eyes with failed filters.

Highlights

Filtering procedures remain the most popular surgical option for controlling intraocular pressure (IOP) in medically refractory glaucoma
All had undergone needling revision between 2008-2010 using the same technique we described previously [14], with the only modification being the use of a single intraoperative intra-bleb infusion with MMC rather than multiple subconjunctival 5-fluorouracil (5-FU) injections for antimetabolite treatment
A small, fan shaped area of teno-conjunctiva was elevated between the entry site and the old sclerostomy by rotating the tip of the needle through the fulcrum of the conjunctival puncture site

Summary

Introduction

Filtering procedures remain the most popular surgical option for controlling intraocular pressure (IOP) in medically refractory glaucoma. Sometimes that failure may take the form of hyperfiltration and hypotony, but more commonly it comes in the form of scarring or encapsulation of the bleb, with or without sclerostomy or scleral flap obstruction. In such cases the surgeon must decide whether to attempt to restore filtration or find other means for lowering IOP. As long as there is no direct uveal obstruction of the internal sclerostomy or nonpenetrating drainage zone, restoration of the original filter remains a viable option [4,5,6,7,8,9,10,11,12,13]

Methods

Results

Conclusion