Needle elevation of the scleral flap for failing filtration blebs after trabeculectomy with mitomycin C

David Greenfield, M. P. Miller, I. J. Suner, Paul Palmberg

Research output: Contribution to journalArticle

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Abstract

PURPOSE: To report the incidence of failing filtration blebs after trabeculectomy with mitomycin C and to report the outcome of needling procedures for failing filtration blebs in these eyes. METHODS: We conducted a retrospective analysis of 537 eyes of 434 patients who had trabeculectomy with mitomycin C and reviewed the clinical course of 441 eyes of 338 patients with a minimum of three months of follow-up. RESULTS: In 441 eyes of 338 patients followed up for three months or more after trabeculectomy with mitomycin C, 88 (20.0%) eyes from 85 patients underwent needle elevation of the scleral flap. Forty-nine (22.4%) of 219 eyes required needle revision after trabeculectomy alone, and 39 (17.6%) of 222 eyes after trabeculectomy combined with cataract extraction and intraocular lens implantation. Mean intraocular pressure (IOP) after needle revision (17.9 ± 11.6 mm Hg) was significantly less than the mean preneedling IOP (27.1 ± 10.4 mm Hg, P < .00001, paired Student's t test). Sixty-three eyes of 60 patients had a minimum of three months of postneedling follow-up. Successful pressure control, defined as an IOP of 22 mm Hg or less with or without topical glaucoma control medications, was achieved in 46 (73.0%) of 63 eyes. Unsuccessful outcomes correlated significantly with higher preneedling lOP (R = 0.28, P = .03, df = 61) and prior surgery involving conjunctival incisions (R = 0.53, P < .00001, df = 61). CONCLUSIONS: Needle elevation of the scleral flap may provide significantly long-lasting pressure reduction in eyes with failing mitomycin C blebs. Higher success rates are achieved in eyes with fewer prior conjunctival incisions, eyes requiring a single needle revision, and eyes with lower preneedling IOP.

Original languageEnglish
Pages (from-to)195-204
Number of pages10
JournalAmerican Journal of Ophthalmology
Volume122
Issue number2
StatePublished - Aug 27 1996
Externally publishedYes

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Trabeculectomy
Mitomycin
Blister
Needles
Intraocular Pressure
Pressure
Intraocular Lens Implantation
Cataract Extraction
Glaucoma

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Needle elevation of the scleral flap for failing filtration blebs after trabeculectomy with mitomycin C. / Greenfield, David; Miller, M. P.; Suner, I. J.; Palmberg, Paul.

In: American Journal of Ophthalmology, Vol. 122, No. 2, 27.08.1996, p. 195-204.

Research output: Contribution to journalArticle

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abstract = "PURPOSE: To report the incidence of failing filtration blebs after trabeculectomy with mitomycin C and to report the outcome of needling procedures for failing filtration blebs in these eyes. METHODS: We conducted a retrospective analysis of 537 eyes of 434 patients who had trabeculectomy with mitomycin C and reviewed the clinical course of 441 eyes of 338 patients with a minimum of three months of follow-up. RESULTS: In 441 eyes of 338 patients followed up for three months or more after trabeculectomy with mitomycin C, 88 (20.0{\%}) eyes from 85 patients underwent needle elevation of the scleral flap. Forty-nine (22.4{\%}) of 219 eyes required needle revision after trabeculectomy alone, and 39 (17.6{\%}) of 222 eyes after trabeculectomy combined with cataract extraction and intraocular lens implantation. Mean intraocular pressure (IOP) after needle revision (17.9 ± 11.6 mm Hg) was significantly less than the mean preneedling IOP (27.1 ± 10.4 mm Hg, P < .00001, paired Student's t test). Sixty-three eyes of 60 patients had a minimum of three months of postneedling follow-up. Successful pressure control, defined as an IOP of 22 mm Hg or less with or without topical glaucoma control medications, was achieved in 46 (73.0{\%}) of 63 eyes. Unsuccessful outcomes correlated significantly with higher preneedling lOP (R = 0.28, P = .03, df = 61) and prior surgery involving conjunctival incisions (R = 0.53, P < .00001, df = 61). CONCLUSIONS: Needle elevation of the scleral flap may provide significantly long-lasting pressure reduction in eyes with failing mitomycin C blebs. Higher success rates are achieved in eyes with fewer prior conjunctival incisions, eyes requiring a single needle revision, and eyes with lower preneedling IOP.",
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