[Clinical observation of needle revision and 5-fluorouracil subconjunctival injection on the dysfunctional filtering blebs].
OBJECTIVE
To investigate the efficacy of needle revision with 5-fluorouracil (5-FU) on the dysfunctional filtration blebs after trabeculectomies and to assess the factors that may impact the success.


METHODS
Fourty eyes of 34 patients underwent the needle revision of the malfunctional blebs with 5-FU at clinic visits in 2 - 8 weeks immediately after trabeculectomies and were followed up for 12 weeks.


RESULTS
After revision through needling procedures, the blebs were diffused and elevated in 26 eyes, thinned and multisystem in 9 eyes, thickened and focalized or invisible in profile in 5 eyes. Intraocular pressures (IOPs) were significantly (P < 0.01) lowered from (23.6 +/- 2.1) mm Hg (1 mm Hg = 0.133 kPa) of pre-needling to (16.3 +/- 2.9) mm Hg of post-needling in 35 functional filtering blebs. The Kaplan-Meier survival curve for the 40 eyes showed a success rate of (87.51 +/- 5.23)% within the follow-up time. Logistic regression did not show significant difference in needle revision among the types of glaucoma, the history of intraocular surgery, and the ages of patients. However, poorer responses were observed following greater intervals of needling operation from previous trabeculectomy (P = 0.046). The time interval for the median efficacy level is 5.9 weeks. Subconjunctival hemorrhage occurred in 6 eyes during the needle revision, and no other post-needling complications were found during the follow-up time.


CONCLUSIONS
The needle revision combined with 5-FU is an effective, safe, and simple method of improving early dysfunctional filtration blebs after trabeculectomies. The success rate of needle revision was about 50% at 6 weeks and the delay of needle revision may result in poor responses.
Ren
Ze-qin
ZQ
Department of Ophthalmology, Peking University Fist Hospital, Beijing 100034, China. renzeqin@163.com
Qiao
Rong-hua
RH
D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D003228:Conjunctiva; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000627:therapeutic use*; D005500:Follow-Up Studies; D005901:Glaucoma / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009339:Needles; D011183:Postoperative Complications / Q000628:therapy; D014130:Trabeculectomy / Q000009:adverse effects; D055815:Young Adult
D005472:Fluorouracil