gms | German Medical Science

The purpose of the study was to determine the efficacy of the postoperative needling revision with adjunctive 5-fluorouracil (5-FU) and to identify any complications of the procedure and risk factors associated with success or failure.

Thirty-eight eyes underwent one to five standard needling procedures at the different time following either trabeculectomy or phaco-trabeculectomy with or without adjunctive mitomycin C. The results of total 60 bleb needling procedures augmented with subconjunctival 5-fluorouracil injection were evaluated within the follow-up period ranging from 1 month to 10 years. Reduction in intraocular pressure (IOP) (>15 mmHg, ≤15 mmHg), number of glaucoma medications, complications and factors associated with outcome were analyzed.

Mean preoperative intraocular pressure was 31.3 mmHg (range, 17 – 49 mmHg). In each eye it dropped immediately following surgery to 11.9 mmHg (≤15 mmHg in 45 cases). One month postoperatively mean IOP was 16.7 mmHg (range, 7 - 44 mmHg) being ≤15 mmHg in 23 cases. Three months following surgery mean IOP was 17.7 mmHg being ≤15 mmHg in 13 cases without hypotensive medications. Twenty-one eyes (55%) had the mean IOP=19.6 mm Hg at 6 months and twenty-two eyes (57.8%) had the mean IOP=19.3 mm Hg at 1 year follow-up. In 3 cases mean IOP was 17.7 mm Hg with no medications at 5 years after needling procedure. Postoperative injections of 5-fluorouracil were applied in 51 cases. The mean number of 5-FU injections was 7.8 (range, 0 – 36 injections). The average number of needling was 1.6, ranging from 0 to 5 procedures. There was a statistically significant reduction in mean number of topical antiglaucoma agents. No serious complications were encountered with the procedure.

These data suggest that needling of filtering bleb augmented with 5-FU is a safe and effective method in re-establishing drainage and lowering intraocular pressure.