title: Outcomes: Trabeculectomy Bleb Needle Revision With 5-Fluorouracil.
abstract: OBJECTIVE
  To evaluate outcomes of trabeculectomy bleb needle revision with 5-fluorouracil augmentation performed in the operating theater.
  
  
  METHODS
  Retrospective study of all patients undergoing trabeculectomy bleb needle revisions in the operating theater performed by a single surgeon in a metropolitan hospital in Australia. A total of 51 needle revisions were performed on 33 eyes over a mean follow-up time of 1.81±1.56 years.
  
  
  RESULTS
  A total of 29% achieved intraocular pressure (IOP) ≤20 mm Hg off all glaucoma medications, and an additional 39% achieved qualified success with the addition of glaucoma medications, giving overall success of 68%. Analyzing success rate for target IOP≤16 mm Hg, 24% achieved target off all glaucoma medications, 35% achieved qualified success with the addition of glaucoma medications, giving an overall success rate of 59%. There was a statistically significant improvement in IOP, as compared with preoperative levels, at all timepoints postoperatively (P<0.05). However, number of glaucoma medications remained unchanged (P>0.05) contributing to the high percentage of qualified successes. Visual acuity remained unchanged and there were no major postoperative complications. The Kaplan-Meier survival shows a survival rate of 60% with IOP≤20 mm Hg and 40% for IOP≤16 mm Hg at 5 years.
  
  
  CONCLUSIONS
  Trabeculectomy needle revision is a useful option for the management of elevated IOP in the presence of a failed or failing trabeculectomy bleb. However, as with trabeculectomy, there tends to be a failure rate over time. This often leads to reinstitution of glaucoma medications and/or further needle revisions to maintain IOPs at target level. The procedure itself is minimally invasive with an acceptable safety profile.
authors.affiliation: Department of Ophthalmology, Concord Repatriation General Hospital, Sydney, NSW, Australia.
authors.forename: Linda
authors.initials: L
authors.lastname: Zheng
authors.forename: Hemamalini
authors.initials: H
authors.lastname: Arvind
authors.forename: David
authors.initials: D
authors.lastname: Wechsler
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage; D000963:Antimetabolites / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005260:Female; 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; D009339:Needles; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D014065:Tonometry, Ocular; D014129:Trabecular Meshwork / Q000503:physiopathology / Q000601:surgery*; D014130:Trabeculectomy / Q000379:methods*; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000959:Antihypertensive Agents; D000963:Antimetabolites; D005472:Fluorouracil