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Operative revision of non-functioning filtering blebs with 5-fluorouracil to regain intraocular pressure control
Article first published online: 28 JUL 2004
DOI: 10.1111/j.1442-9071.2004.00841.x
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How to Cite
Paris, G., Zhao, M. and Sponsel, W. E. (2004), Operative revision of non-functioning filtering blebs with 5-fluorouracil to regain intraocular pressure control. Clinical & Experimental Ophthalmology, 32: 378–382. doi: 10.1111/j.1442-9071.2004.00841.x
Publication History
- Issue published online: 28 JUL 2004
- Article first published online: 28 JUL 2004
- Abstract
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Keywords:
- 5-fluorouracil;
- antimetabolite;
- eye surgery;
- glaucoma;
- trabeculectomy
Abstract
Purpose: To determine the efficacy of extensive microsurgical needling revision of failed filtering blebs followed by serial 5-fluorouracil subconjunctival injections.
Methods: Thirty-six eyes of 34 consecutive patients with progressive open-angle glaucoma refractory to topical therapy submitted to needling revision as a major procedure. All patients required multiple antiglaucoma medications preoperatively, and had completely flat or densely encapsulated filtering blebs. All patients underwent elaborate needling revision (limbus to superior rectus >8 mm diameter, >3 mm elevation, entry-site sutured with 8−0 vicryl and bleb reformed via paracentesis with viscoelastic) in the operating room, followed by serial 5-fluorouracil. The patients were followed for up to 6 months postoperatively. The main outcome measures were intraocular pressure (IOP) and the number of antiglaucoma medications used.
Results: Thirty-one eyes (86%) maintained mean IOP below 15 mmHg postneedling without medication. Overall the mean IOP postneedling was >9 mmHg lower than medicated preoperative levels (P < 0.0001). IOP reduction in encapsulated blebs was marginally superior to that in flat blebs.
Conclusions: Extensive needling revision in the operating room is safe, straightforward, and produces reproducible restoration of filtering function.