title: Needling augmented with topical application of mitomycin C for management of bleb failure.
abstract: OBJECTIVE
  To study the effect of topical application of mitomycin C on enhancing the efficacy of needling in the management of bleb failure.
  
  
  METHODS
  Thirty-six eyes of 32 consecutive patients with an intraocular pressure over 21 mmHg, without bleb or with a thick, flat bleb after the second postoperative month after trabeculectomy, were included in the study. Needling with mitomycin C was performed in the other 18 eyes with bleb failure (group A) and needling without antimetabolite was performed in 18 eyes (group B). Topical application of mitomycin C (0.4 mg/mL) with a microsponge over the conjunctiva at the failed bleb for 5 minutes (group A) was performed; after irrigation, the needling procedure was the same in both groups. A 30-gauge needle was used to perforate the area of subconjunctival and subscleral fibrosis and to reestablish flow; conjunctival puncture was at least 7 mm away from the bleb and no sutures were taken after needling. Follow-up was performed for 1 year after needling.
  
  
  RESULTS
  Overall, 55 needling procedures were performed; needling was done twice in 17 eyes in group B, whereas only 2 eyes needed more than 1 needling procedure in group A. The difference was statistically highly significant, and the mean follow-up was 8.9 ± 3.7 months. Mean intraocular pressure was 28.9 ± 4.2 mm Hg and 27.8 ± 4.7 mm Hg in group A and group B respectively before any intervention; this decreased to a mean of 19.8 ± 2.7 mm Hg and 20.5 ± 4.8 mm Hg respectively without medication after 6 months of last needling. Complications included diffuse corneal punctate epitheliopathy lasting for 2 to 3 weeks (2 eyes in group A), subconjunctival hemorrhage (3 eyes in each group), and hyphema (2 eyes in each group).
  
  
  CONCLUSIONS
  Topical application of mitomycin C with needle revision seems to be an extremely effective way to revive failed filtration surgery. The incidence of complications related to mitomycin C was minimal.
authors: Faculty of Medicine, Suez Canal University, Egypt. eeghoneim@hotmail.com
authors: Ehab Mahmoud
authors: EM
authors: Ghoneim
authors: Mohamed
authors: M
authors: Abd El Hameed
mesh_terms: D000287:Administration, Topical; D000477:Alkylating Agents / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D003228:Conjunctiva / Q000187:drug effects*; D005260:Female; D005355:Fibrosis; D018463:Filtering Surgery; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D009339:Needles; D011677:Punctures / Q000379:methods*; D012590:Sclera / Q000473:pathology; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000477:Alkylating Agents; D016685:Mitomycin