Needle revision of failing and failed trabeculectomy blebs with adjunctive 5-fluorouracil: survival analysis.
OBJECTIVE
To report the outcome of 5-fluorouracil (5-FU)-augmented bleb needling revision of failed and failing filtration blebs and to identify risk factors for failure, indicators for success, and any complications of the procedure.


METHODS
Prospective, observational, noncomparative, interventional case series with survival analysis.


METHODS
The results of 101 bleb needling procedures augmented with subconjunctival 5-FU injection were determined after a minimum follow-up of 9 months. Kaplan-Meier plots were constructed and a Cox proportional hazards regression analysis was performed to assess the association between study factors and time to failure.


METHODS
Reduction in intraocular pressure (IOP) by 2 criteria (<22 mmHg, >30%), glaucoma medications, complications, and factors associated with outcome.


RESULTS
At the time of their last follow-up visit, 60 eyes had an IOP <22 mmHg, mean IOP being reduced from 26.5 mmHg to 15 mmHg [corrected] after a median of 1 needling procedure (mean, 1.6). The median interval between the "index" filtration surgery and the first (or only) needling procedure was 3.1 months, with a range of 10 days to 11 years. There was a reduction in mean number of topical antiglaucoma agents from 0.7 to 0.2 per successful eye and a median follow-up duration of 18.7 months (range, 9.3-52.8 months [corrected]). Thus, the overall cross-sectional success rate of the procedure at the time of the last visit was 59.4%. Strong evidence was found for an association between the immediate attainment of a low IOP (<11 mmHg) and longer survival times. None of the other proposed factors that may have affected outcome were identified as having a statistically significant effect; however, this may have been the result of the low statistical power for some of the factors in this study.


CONCLUSIONS
These data suggest that bleb needling augmented with 5-FU is a safe and effective method by which a significant number of failed or failing filtration blebs can be rescued from failure. Attaining an immediate reduction in IOP to <11 mmHg seems to be a favorable factor with respect to reasonably long-term efficacy .
Broadway
David C
DC
Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk NR4 7UZ, United Kingdom. david.broadway@nnuh.nhs.uk
Bloom
Philip A
PA
Bunce
Catey
C
Thiagarajan
Manickam
M
Khaw
Peng T
PT
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001768:Blister / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D003228:Conjunctiva / Q000473:pathology; D005260:Female; D005355:Fibrosis; D005472:Fluorouracil / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009339:Needles; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012086:Reoperation; D012307:Risk Factors; D016019:Survival Analysis; D014130:Trabeculectomy; D017211:Treatment Failure; D016896:Treatment Outcome
D005472:Fluorouracil