Internal Revision with Bleb Needling: An Effective, Safe Option for Failing Blebs

Abstract

Aim: To report the outcomes of internal revision with bleb needling in cases of failing blebs with the internal sclerostomy blocked by iris tissue.
 Methods: Prospective study of 26 eyes of 26 patients with failing blebs where target IOP was not achieved with 2 anti-glaucoma drugs and sclerostomy was blocked by iris (confirmed on gonioscopy). Patients were divided into 3 groups depending on the time from the first surgery- early (<3 months), intermediate (4-12 months) and late (>1 year). Patients underwent internal revision with bleb needling with either 5-Fluorouracil (5-FU) or Mitomycin C (MMC)
 Results: 26 eyes of 26 patients were included in the study. Mean age was 51.35±14.5 years. Time from the filtration surgery was early in 3, intermediate in 5 and late in 18 eyes. Mean IOP reduction at 3 months was 32±18% with maximum reduction in early group (40%). Mean IOP decreased from 24.5±3.4 mmHg to 16.2±4.3 mmHg in 5-FU group (12 patients) and 27.4±9 mmHg to 18.2±6.6 mmHg in MMC group (14 patients). Self-limiting complications were hyphema in 2 patients and subconjunctival haemorrhage in 1 patient.
 Conclusion: Internal revision with bleb needling is a safe and effective procedure for reviving failing blebs.