Needling augmented with topical application of mitomycin C for management of bleb failure.

Abstract

PURPOSE:

To study the effect of topical application of mitomycin C on enhancing the efficacy of needling in the management of bleb failure.

PATIENTS AND METHODS:

Thirty-six eyes of 32 consecutive patients with an intraocular pressure over 21 mmHg, without bleb or with a thick, flat bleb after the second postoperative month after trabeculectomy, were included in the study. Needling with mitomycin C was performed in the other 18 eyes with bleb failure (group A) and needling without antimetabolite was performed in 18 eyes (group B). Topical application of mitomycin C (0.4 mg/mL) with a microsponge over the conjunctiva at the failed bleb for 5 minutes (group A) was performed; after irrigation, the needling procedure was the same in both groups. A 30-gauge needle was used to perforate the area of subconjunctival and subscleral fibrosis and to reestablish flow; conjunctival puncture was at least 7 mm away from the bleb and no sutures were taken after needling. Follow-up was performed for 1 year after needling.

RESULTS:

Overall, 55 needling procedures were performed; needling was done twice in 17 eyes in group B, whereas only 2 eyes needed more than 1 needling procedure in group A. The difference was statistically highly significant, and the mean follow-up was 8.9 ± 3.7 months. Mean intraocular pressure was 28.9 ± 4.2 mm Hg and 27.8 ± 4.7 mm Hg in group A and group B respectively before any intervention; this decreased to a mean of 19.8 ± 2.7 mm Hg and 20.5 ± 4.8 mm Hg respectively without medication after 6 months of last needling. Complications included diffuse corneal punctate epitheliopathy lasting for 2 to 3 weeks (2 eyes in group A), subconjunctival hemorrhage (3 eyes in each group), and hyphema (2 eyes in each group).

CONCLUSIONS:

Topical application of mitomycin C with needle revision seems to be an extremely effective way to revive failed filtration surgery. The incidence of complications related to mitomycin C was minimal.

• Authors: Ehab Mahmoud Ghoneim, Mohamed Abd El Hameed
• Journal: Journal of glaucoma (J Glaucoma) Vol. 20 Issue 8 Pg. 528-32 (Oct 2011) ISSN: 1536-481X [Electronic] United States
• PMID: 21878816 (Publication Type: Journal Article)

Chemical References

• Alkylating Agents
• Mitomycin

Topics

• Administration, Topical
• Alkylating Agents (administration & dosage)
• Combined Modality Therapy
• Conjunctiva (drug effects)
• Female
• Fibrosis
• Filtering Surgery
• Follow-Up Studies
• Glaucoma, Open-Angle (drug therapy, surgery)
• Humans
• Intraocular Pressure (physiology)
• Male
• Middle Aged
• Mitomycin (administration & dosage)
• Needles
• Punctures (methods)
• Sclera (pathology)
• Treatment Failure
• Treatment Outcome