title: Needle Revision With 5-fluorouracil for the Treatment of Ahmed Glaucoma Valve Filtering Blebs: 5-Fluoruracil Needling Revision can be a Useful and Safe Tool in the Management of Failing Ahmed Glaucoma Valve Filtering Blebs.
abstract: OBJECTIVE
  To determine the outcome of needling with adjunctive 5-fluorouracil (5-FU) in patients with a failing Ahmed glaucoma valve (AGV) implant, and to identify predictors of long-term intraocular pressure (IOP) control.
  
  
  METHODS
  A prospective observational study was performed on consecutive patients with medically uncontrolled primary open-angle glaucoma (POAG) with AGV encapsulation or fibrosis and inadequate IOP control. Bleb needling with 5-FU injection (0.1 mL of 50 mg/mL) was performed at the slit-lamp. Patients were examined 1 week following the needling, and then at months 1, 3, and 6. Subsequent follow-up visits were scheduled at 6-month intervals for at least 2 years. Needling with 5-FU was repeated no more than twice during the first 3 months of the follow-up. Procedure outcome was determined on the basis of the recorded IOP levels.
  
  
  RESULTS
  Thirty-six patients with an encapsulated or fibrotic AGV underwent 67procedures (mean 1.86 ± 0.83). Complete success, defined as IOP ≤ 18 mm Hg without medications, was obtained in 25% at 24 months of observation. The cumulative proportion of cases achieving either qualified (ie, IOP ≤ 18 mm Hg with medications) or complete success at 24 months of observation was 72.2%. In a univariate Cox proportional hazards model, age was the only variable that independently influenced the risk of failing 5-FU needling revision. Fourteen eyes (38.8%) had a documented complication.
  
  
  CONCLUSIONS
  Needling over the plate of an AGV supplemented with 5-FU is an effective and safe choice in a significant proportion of POAG patients with elevated IOP due to encapsulation or fibrosis.
authors.affiliation: *Department of Medical-Surgical Specialties and Public Health, Centre for the Study of Glaucoma, University of Brescia, Brescia †Laboratory of Clinical Research, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy ‡Ophthalmology Department, University of Ioannina, Ioannina §1st and 3rd University Departments of Ophthalmology, Aristotle University, Thessaloniki, Greece.
authors.forename: Luciano
authors.initials: L
authors.lastname: Quaranta
authors.forename: Irene
authors.initials: I
authors.lastname: Floriani
authors.forename: Lital
authors.initials: L
authors.lastname: Hollander
authors.forename: Davide
authors.initials: D
authors.lastname: Poli
authors.forename: Andreas
authors.initials: A
authors.lastname: Katsanos
authors.forename: Anastasios G P
authors.initials: AG
authors.lastname: Konstas
mesh_terms: D000368:Aged; D000963:Antimetabolites / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005260:Female; D018463:Filtering Surgery; D005472:Fluorouracil / Q000008:administration & dosage*; D005500:Follow-Up Studies; D020327:Glaucoma Drainage Implants; D005902:Glaucoma, Open-Angle / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009339:Needles; D011446:Prospective Studies; D012086:Reoperation; D014065:Tonometry, Ocular; D017211:Treatment Failure
chemical_list: D000963:Antimetabolites; D005472:Fluorouracil