title: Long-term outcomes of needle revision of failing deep sclerectomy blebs.
abstract: OBJECTIVE
  To report on long-term outcomes of mitomycin C (MMC)-augmented needle revision of failing deep sclerectomy (DS) blebs.
  
  
  METHODS
  Retrospective database search of all needle revisions with MMC for DS blebs between 2002 and 2008 was conducted. Sixty-six eyes of 66 patients were included in the study. Subconjunctival MMC 0.01-0.02 mg was injected 15 min before needle revision. Complete success was defined as intraocular pressure ≤ 18 mmHg or 20% decrease from baseline with no glaucoma medications or further surgical procedures. Partial success was based on the same criteria, but with medications.
  
  
  RESULTS
  Mean follow-up after index needle revision was 67.8 ± 24.8 months (range 1-10 years). The mean number of needle revisions was 1.6 ± 0.8 (range 1-4). Two or more procedures were done in 31 eyes (47.0%). Mean preoperative intraocular pressure was 23.2 ± 6.9 mmHg. Complete and partial success rates were 64% and 71% at 1 year, 57% and 68% at 3 years, and 40 % and 58 % at 5 years after surgery, respectively. Early needle revision, within 6 months of index surgery, was significantly associated with failure, both on uni- and multivariate tests. Significant complications included delayed hypotony in five eyes (7.6%), delayed bleb leak in two eyes (3.0%), endophthalmitis in one eye (1.5%), and corneal oedema in two eyes (3.0%).
  
  
  CONCLUSIONS
  Needle revision with subconjunctival MMC may successfully lower the intraocular pressure in eyes with a failing DS bleb in the long term. Complications known to be associated with trabeculectomy and MMC were anticipated and observed in our DS group.
authors.affiliation: Department of Ophthalmology, FRCOphth, Royal Free Hospital, Pond Street, NW3 2QG, London, UK, antigoni_koukkoulli@hotmail.com.
authors.forename: Antigoni
authors.initials: A
authors.lastname: Koukkoulli
authors.forename: Fayyaz
authors.initials: F
authors.lastname: Musa
authors.forename: Nitin
authors.initials: N
authors.lastname: Anand
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000477:Alkylating Agents / Q000008:administration & dosage; D003228:Conjunctiva / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D016685:Mitomycin / Q000008:administration & dosage; D012086:Reoperation; D012189:Retrospective Studies; D012599:Sclerostomy / Q000379:methods*; D054047:Surgical Stomas
chemical_list: D000477:Alkylating Agents; D016685:Mitomycin