title: 5-Fluorouracil augmented needle revision of trabeculectomy: does the location of outflow resistance make a difference?
abstract: OBJECTIVE
  To determine whether the outcome of needle revision of trabeculectomy is influenced by the presumed anatomic location of resistance to aqueous outflow.
  
  
  METHODS
  Retrospective case note review.
  
  
  METHODS
  Thirty-four eyes of 30 consecutive patients undergoing their first needle revision of trabeculectomy.
  
  
  METHODS
  We compared 2 types of needle revision: "type-1 needling," limited to breaking down fibrosis in the subconjuctival-subtenon space, and "type-2 needling," which additionally involved needling underneath the scleral flap.
  
  
  METHODS
  Unqualified success was defined as a postneedling intraocular pressure (IOP) >4 mm Hg and ≤21 mm Hg at the most recent follow-up without further surgery, medications, or repeat needling. Qualified success was defined as a successful patient who required medications or repeat needling.
  
  
  RESULTS
  The mean follow-up period was 2.1 ± 0.1 years (range, 1.0 to 3.8 y). Sixteen type-1 and 18 type-2 procedures were performed at a median of 124 days (22 d to 14 y) after trabeculectomy. IOP decreased from a mean of 28.2±1.3 mm Hg (19 to 52 mm Hg) preneedling to 6.7±0.8 mm Hg (2 to 22 mm Hg) on the first postoperative visit and 15.1±0.7 mm Hg (8 to 27 mm Hg) at the most recent follow-up. The overall success rate was 82.4% (47.1% unqualified and a further 35.3% qualified). There was no significant difference in the success rates between type-1 (14/16) and type-2 (14/18) needle revisions (Fisher exact test, P=0.66). Similar proportions of eyes undergoing type-1 and type-2 needling underwent a second needling procedure. There was no significant difference in the IOP reduction between type-1 and type-2 needling (Mann-Whitney U test, P=0.78).
  
  
  CONCLUSIONS
  Needle revision is an effective technique for trabeculectomy bleb remodeling and can result in a sustained reduction in IOP. The location of the obstruction did not influence outcome, with type-1 and type-2 needle revisions equally likely to succeed.
authors.affiliation: Department of Ophthalmology, University Hospitals Leicester, Infirmary Square, Leicester, UK. andrewtatham@yahoo.co.uk
authors.forename: Andrew
authors.initials: A
authors.lastname: Tatham
authors.forename: Usman
authors.initials: U
authors.lastname: Sarodia
authors.forename: Wojciech
authors.initials: W
authors.lastname: Karwatowski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000494:pharmacology; D002648:Child; D003228:Conjunctiva / Q000473:pathology / Q000601:surgery; D005260:Female; D005472:Fluorouracil / Q000494:pharmacology*; D005500:Follow-Up Studies; D005901:Glaucoma / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009339:Needles; D012086:Reoperation; D012189:Retrospective Studies; D014130:Trabeculectomy / Q000009:adverse effects*; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil