Office-based slit-lamp needle revision with adjunctive Mitomycin-C for late failed or encapsulated filtering blebs

Abstract

Purpose: The purpose of this study was to assess the results of bleb needling in glaucomatous patients with late failed filtering blebs. Materials and Methods: A retrospective case series of 27 eyes of 27 patients was considered. All patients underwent needle bleb revision with adjuvant mitomycin-C performed at the slit lamp, during an office visit. Complete success was defined as postneedling intraocular pressure (IOP) < 21 mmHg without any antiglaucoma medications and qualified success was IOP < 21 mmHg with topical antiglaucoma medications. Results: There were 12 eyes with encapsulated blebs and 15 eyes with flat blebs. The mean interval between index filtering surgery and bleb revision was 32.74 +- 15.36 months. Mean IOP was 25.07 +- 4.80 mmHg before surgery and 19.66 +- 4.97 mmHg at last postoperative follow-up. The mean follow-up was 20.31 +- 15.63 months. Complete and qualified successes were 7.4% and 51.9%, respectively. Cumulative rates of success at 1, 2, 3, and 4 years were 76%, 65%, 49%, and 37%, respectively. The mean number of antiglaucoma medications was reduced from 3.15 +- 0.36 preoperatively to 2.33 +- 1.21 postoperatively (P<0.001). Conclusion: Slit-lamp needle revision in office is a simple and effective method for treating late encapsulated or flat filtering blebs without significant complications even for late bleb failure.