Needling-revision of failed filtering blebs.

Objective: To investigate the efficacy and safety of needling-revision of failed blebs after trabeculectomy.

Methods: A retrospective chart review of 28 eyes of 28 patients who underwent a trabeculectomy with subsequent needling-revision between January 2002 and December 2003. The mean follow-up was 15 months after the first needling-revision. All interventions were conducted by the same surgeon. Absolute success was defined as an IOP <18 mmHg without medication or as an IOP reduction > 20% without medication if the preoperative IOP was < or = 21 mmHg. Relative success was defined as meeting these criteria with or without medication.

Results: The mean interval between trabeculectomy and the first needling-revision was 5 months. Repeated needling-revision (up to 3 times) was performed as clinically necessary. In 90% of the needling-revisions 5-FU was used to prevent postoperative fibrosis. The mean +/- SD IOP before needling-revision and at the last follow-up was respectively 24.7 +/- 6 and 15.7 +/- 3 mmHg (p<0.001) Needling-revision was an absolute success in 39% (11/28) and a relative success in 68% (19/28). Minor complications attributed to needling-revision occurred in 32% including self reabsorbing subconjunctival bleeding (1), filamental (1) and punctate keratitis (1), transient choroidal effusion (3), wound leak (4) and hyphaema (2). Progression of cataract occurred in 1 patient. A serious complication occurred in 1 case (hypotony with persistent macular oedema).

Conclusions: Bleb needling-revision can prevent more invasive intervention in a significant number of patients with failed trabeculectomy blebs. Complications are similar to those seen after trabeculectomy.