Abstract
PurposeInfrared monitor-guided bleb revision (IRGBR), an alternative needling system, visualizes anterior-segment tissues around the bleb not visible during needle revision after trabeculectomy. This study determined the safety and efficiency of 5-fluorouracil (5-FU) as an adjunctive anti-metabolite in IRGBR.MethodsWe retrospectively analyzed 43 consecutive eyes (40 patients; 14 eyes, primary open-angle; 29 eyes, secondary glaucoma) treated with IRGBR for failing filtering blebs. The patients were divided into two groups. The first one had IRGBR without adjunctive 5-FU subconjunctival injection, and the second one had IRGBR with 5-FU. We performed Kaplan-Meier survival analysis using log-rank tests after 2 years of follow-up and Cox proportional hazards regression model to analyze the dependence of the survival time on predictor variables. Two failure criteria were defined as the need for additional surgery for intraocular pressure (IOP) reduction and the IOP at two consecutive follow-up visits based on definition 1, IOP ≧22 mmHg and definition 2, IOP ≧17 mmHg.ResultsThirty eyes (29 cases) underwent IRGBR with subconjunctival 5-FU injection (group A in the second term) and 13 eyes (11 cases) without 5-FU (group B in the first term). The success rates 24 months after IRGBR were 73.3 and 23.1%, respectively, in groups A and B based on the definition 1 failure and 56.7 and 7.7% based on the definition 2 failure. Complications included transient bleb leaks (group A, 3 eyes; group B, none) and choroidal detachment (group A, 1 eye; group B, none). No use of 5-FU and IOPs ≧10 mmHg 1 week after IRGBR were significant risk factors.ConclusionsAdjunctive 5-FU in IRGBR achieved a better success rate for failing trabeculectomy blebs.
Highlights
Thirty eyes (29 cases) underwent Infrared monitor-guided bleb revision (IRGBR) with subconjunctival 5-FU injection and 13 eyes (11 cases) without 5-FU
We developed the infrared monitor-guided bleb revision (IRGBR) procedure, which uses an infrared monitor to perform the bleb revision with little damage to the scleral flap [2]. 5-Fluorouracil (5-FU), which has
Using failure definition 1, 5-FU and intraocular pressure (IOP) 1 week after IRGBR were significant risk factors for IRGBR failure according to a univariable analysis and 5-FU, IOP 1 week, and age after IRGBR were significant in a multivariable analysis (ORs, 4.90, 5.54, 3.55; 95% Confidence intervals (CIs), 1.37– 17.5, 1.31–23.4, 1.06–11.9; P = 0.01, P = 0.02, P = 0.04, respectively)
Summary
Thirty eyes (29 cases) underwent IRGBR with subconjunctival 5-FU injection (group A in the second term) and 13 eyes (11 cases) without 5-FU (group B in the first term). The success rates 24 months after IRGBR were 73.3 and 23.1%, respectively, in groups A and B based on the definition 1 failure and 56.7 and 7.7% based on the definition 2 failure. Complications included transient bleb leaks (group A, 3 eyes; group B, none) and choroidal detachment (group A, 1 eye; group B, none). No use of 5-FU and IOPs ≧10 mmHg 1 week after IRGBR were significant risk factors
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