The efficacy of 5-fluorouracil bleb needling performed 1 year or more posttrabeculectomy: a retrospective study.
OBJECTIVE
To determine the efficacy of a subconjunctival needling revision using 5-fluorouracil (5FU) when administered to patients who have nonfiltering, flat, or encapsulated blebs over 1 year after the original surgery.


METHODS
The charts of 37 glaucoma patients, who had undergone both a trabeculectomy filtering procedure and a subconjunctival 5FU needling revision, with a minimum interval of 1 year between these procedures and with no intervening surgical procedures, were retrospectively reviewed. The needling was a clinic procedure using a 30-gauge needle and 0.1 mL of 50 mg/mL 5FU.


RESULTS
Intraocular pressure (IOP) decreased by an average of 10.5 mm Hg (44.8%) immediately after the needling procedure. Eleven eyes (29.7%) achieved absolute success, defined as IOP control with no further needling revision, surgical intervention, or antiglaucoma medication in the 2-year follow-up period. Thirteen eyes (35.1%) achieved a qualified success, defined as IOP control with resumed medication use, undergoing a laser procedure, or a repeat needling within the follow-up period. Thirteen eyes (35.1%) failed the procedure by requiring a repeat surgical intervention. The mean IOP was 16.3+/-4.6 mm Hg in the success group, 15.5+/-6.5 mm Hg in the qualified success group, and 27.7+/-8.9 mm Hg in the failure group at the end of follow-up.


CONCLUSIONS
Late 5FU needling is an effective method to control IOP and avoid further surgery in a high proportion of patients with medically uncontrolled nonfiltering blebs.
Kapasi
Mustafa S
MS
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada.
Birt
Catherine M
CM
D000368:Aged; D000369:Aged, 80 and over; D003228:Conjunctiva / Q000187:drug effects / Q000473:pathology*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage*; D005500:Follow-Up Studies; D005901:Glaucoma / Q000601:surgery; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy* / Q000473:pathology; D011677:Punctures / Q000295:instrumentation*; D012086:Reoperation; D012189:Retrospective Studies; D014130:Trabeculectomy / Q000009:adverse effects*; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D005472:Fluorouracil