title: Single needle revision of failing filtration blebs: a retrospective comparative case series with 5-fluorouracil and mitomycin C.
abstract: OBJECTIVE
  To assess the success of needling in failed filtration blebs and the potential benefit of using either 5-fluorouracil (5-FU) or mitomycin C (MMC).
  
  
  METHODS
  In this retrospective, comparative observational case series, 107 eyes that underwent needle revision with either 5-FU or MMC between July 2003 and May 2008 at Wills Eye Institute were selected. Exclusion criteria included follow-up less than 1 month and a history of glaucoma drainage device. Intraocular pressure (IOP) and number of glaucoma medications were recorded preoperatively and postoperatively. Success was defined as >20% decrease in IOP if glaucoma medications were resumed or <10% decrease in IOP if medications were not resumed post needling or fewer medications than pre needling.
  
  
  RESULTS
  Sixty-five patients received 5-FU and 42 patients received MMC for needling. Mean IOP changed from 23.9 mmHg to 13.8 mmHg in the MMC group and from 23.3 mmHg to 13.02 mmHg in the 5-FU group (both p<0.001). Mean glaucoma medications changed from 1.7 to 0.7 in the MMC group and 2.0 to 0.8 in the 5-FU group (both p<0.001) at the end of follow-up. After a mean follow-up of 14.5 months, overall survival was 49.5%. Mean time to failure was 7.7 months. There was a moderately weak association between survival and the immediate postoperative IOP (r=0.262, p=0.01). In comparing MMC and 5-FU, there was no statistically significant difference in survival rate (p=0.267).
  
  
  CONCLUSIONS
  Bleb needling may be a safe and effective means of prolonging bleb survival. The only factor associated with success was the immediate postoperative IOP. There was no apparent difference between the use of 5-FU and MMC in this population. A prospective study may provide further confirmation of this finding.
authors.affiliation: William and Anna Goldberg Glaucoma Service, Wills Eye Institute, 840 Walnut Street, Philadelphia, PA 19107, USA.
authors.forename: Neal
authors.initials: N
authors.lastname: Palejwala
authors.forename: Parul
authors.initials: P
authors.lastname: Ichhpujani
authors.forename: Ghasem
authors.initials: G
authors.lastname: Fakhraie
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Myers
authors.forename: Marlene R
authors.initials: MR
authors.lastname: Moster
authors.forename: L Jay
authors.initials: LJ
authors.lastname: Katz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000963:Antimetabolites / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005260:Female; D018463:Filtering Surgery; D005472:Fluorouracil / Q000008:administration & dosage*; D005500:Follow-Up Studies; D005901:Glaucoma / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D009339:Needles; D011677:Punctures; D012086:Reoperation; D012189:Retrospective Studies; D014065:Tonometry, Ocular
chemical_list: D000963:Antimetabolites; D016685:Mitomycin; D005472:Fluorouracil