title: Bleb needling with subconjunctival injection of sodium hyaluronate 1.4%: 1-year outcomes.
abstract: OBJECTIVE
  To assess the safety and efficacy of 5-fluorouracil (5-FU)-augmented bleb needling revision (BNR) with subconjunctival Healon GV (sodium hyaluronate 1.4%) over a 12-month follow-up.
  
  
  METHODS
  Retrospective consecutive case series.
  
  
  METHODS
  We studied 54 patients who had undergone primary BNR with adjunctive 5-FU and routine subconjunctival Healon GV between 2004 and 2007.
  
  
  METHODS
  BNR was performed using multiple puncturing motions through the bleb: a 0.4 mL Healon GV injection between the bleb and conjunctiva; and a 5-FU (10 mg in 0.4 mL) injection into the substance of Healon GV. Success was defined as follows: (1) complete success, indicating intraocular pressure (IOP) reduction ≥ 20% and to ≤ 21 mm Hg but > 5 mm Hg without antiglaucoma medication; or (2) qualified success, indicating IOP reduction ≥ 20% and to ≤ 21 mm Hg but > 5 mm Hg with or without antiglaucoma medication. Patients requiring additional filtration surgery during the 12-month follow-up period were considered failures.
  
  
  RESULTS
  Data collection was completed for 53 eyes of 46 patients. The IOP fell from a preoperative mean of 22.7 ± 7.95 mm Hg to 16.3 ± 4.34 mm Hg at 12 months (p < 0.001). The complete success rate was 26.4%; the qualified success rate was 43.4%. Of the eyes studied, 28 (52.8%) achieved IOPs of ≤ 16 mm Hg at 12 months. Complications occurred in 16 eyes (30%), and 3 required surgical intervention.
  
  
  CONCLUSIONS
  Subconjunctival Healon GV in 5-FU-augmented bleb needling revision is a relatively safe and effective technique for reducing IOP in the short to medium term, and it involves few significant complications.
authors.affiliation: Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK.
authors.forename: Fariha
authors.initials: F
authors.lastname: Shafi
authors.forename: Pavi
authors.initials: P
authors.lastname: Agrawal
authors.forename: Roger
authors.initials: R
authors.lastname: Holder
authors.forename: Velota
authors.initials: V
authors.lastname: Sung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000477:Alkylating Agents / Q000008:administration & dosage*; D003228:Conjunctiva / Q000187:drug effects / Q000601:surgery*; D004359:Drug Therapy, Combination; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage*; D005901:Glaucoma / Q000601:surgery*; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007267:Injections; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009339:Needles; D011677:Punctures; D012189:Retrospective Studies; D019738:Surgically-Created Structures; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000477:Alkylating Agents; D006820:Hyaluronic Acid; D005472:Fluorouracil