Jornal de Oftalmologia Clínica e Experimental
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Effectiveness of Needling Revision with Mitomycin-C for Failing Blebs

Sylvia L. Groth and William Eric Sponsel

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.