NEEDLE REVISION WITH MITOMYCIN-C IN ENCAPSULATED BLEBS

Abstract

The most common cause of failure during the first trimester after trabeculectomy is encapsulated bleb and needling bleb revision is a less invasive method in the management of refractory cases. The purpose of this study is to determine the efficacy and safety of mitomycin-C (MMC) augmented bleb revision of failed filtration surgery. This study is a before-after (paired) observation. 33 patients with failed trabeculectomy because of bleb encapsulation, whose intraocular pressure (IOP) was not reduced under 21 mmHg despite of medications and digital massage , underwent needling bleb revision and subconjunctival injection of 0.1 ml MMC (0.4 mg/ml).The mean follow-up time was 9.24 ± 5.27 months (1-20 months). Statistical analysis of the data included the paired two-tailed Student's t test for preoperative and postoperative IOP and number of medications. 36 needling procedures (mean, 1.09 ± 0.21 revisions per eye) were performed on 33 eyes. Patients were between 10-80 years old (mean, 45.67 ± 22.41 years) and mean follow-up was 9.24 ± 5.27 months. IOP decreased from 29.06 ± 5.03 mmHg to 18.21 ± 6.76 mmHg at last follow-up (P= 0.000). Antiglaucoma medications decreased from 2.18 ± 0.58 to 1.36 ± 0.29 at last follow-up (P= 0.000).Overall, 6 (18.2%) of 33 cases achieved a complete success and 20 (60.6%) of cases achieved a qualified success. The complications of this procedure were subconjunctival hemorrhage (17 cases), hyphema (5 cases) and conjunctival button hole (2 cases). Needling bleb revision with mitomycin-C appears to be an effective and relatively safe way to revive failed filtration surgery.