title: Frequency of bleb manipulations after trabeculectomy surgery.
abstract: OBJECTIVE
  To quantify the type and frequency of postoperative bleb manipulations undertaken after modern glaucoma surgery.
  
  
  METHODS
  Bleb manipulations were recorded after trabeculectomy surgery on 119 consecutive patients with at least 1 year of follow-up. The type of intervention and time after surgery were recorded. Statistical analysis identified success rates at various intraocular pressure (IOP) cut-off definitions and identified factors that increased the risk for bleb manipulation.
  
  
  RESULTS
  In all, 78.2% of trabeculectomies were followed by some form of bleb manipulation. Almost 49% of blebs underwent massage and a similar number required at least one suture removal, 31.1% required at least one 5-fluorouracil (5-FU) injection and 25.2% required at least one needling and 5-FU injection. The median time to the first intervention for massage, suture removal, 5-FU injection, and needling and 5-FU injection were 1, 14, 14 and 43 days, respectively. IOP measurements were higher at all follow-up time points in the intervention group. Failure to achieve specific IOP target pressures was also generally poorer in the 5-FU, and needling and 5-FU intervention groups.
  
  
  CONCLUSIONS
  Postoperative intervention is a frequent occurrence after modern glaucoma surgery. This requires intensive postoperative follow-up and is a labour-intensive undertaking. Despite interventions in our group of patients, IOP in the intervention group was always higher than in the group that required no intervention.
authors.affiliation: Department of Ophthalmology, Eye and Ear Building, Queens Medical Centre, Nottingham NG7 2UH, UK. anthony.king@nuh.nhs.uk
authors.forename: A J
authors.initials: AJ
authors.lastname: King
authors.forename: A P
authors.initials: AP
authors.lastname: Rotchford
authors.forename: A
authors.initials: A
authors.lastname: Alwitry
authors.forename: J
authors.initials: J
authors.lastname: Moodie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000963:Antimetabolites / Q000627:therapeutic use; D001768:Blister / Q000209:etiology / Q000628:therapy*; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009339:Needles; D011182:Postoperative Care / Q000379:methods*; D011312:Pressure; D012307:Risk Factors; D013537:Sutures; D014130:Trabeculectomy; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000963:Antimetabolites; D005472:Fluorouracil