5-Fluorouracil-needling and paracentesis through the failing filtering bleb

Standard needle revision of the filtering bleb after glaucoma filtration surgery has many disadvantages. This study reports the technique and outcome of a modified needling of the failing bleb.

Consecutive patients who presented with increased intraocular pressure (lOP) and open internal ostium were included in this prospective study. When their IOP rose to levels >20 mm Hg despite various therapeutic regimens and visibility of the sclerostomy site was unclear, the modified needling technique was conducted. In each needling, a total dose of 1 mg (0.1 mL) of 5-fluorouracil (FU) was administered subconjunctivally, adjacent and into the bleb. The needle was then passed via the bleb, anterior to the sclera, through the anterior limbus to penetrate intracamerally. Standard treatment to inhibit bleb scarring followed.

Twelve 5-FU-needle revisions were performed on 8 eyes. The first needle revision was performed 51.1+/-36.2 days (range, 5-117) postoperatively. IOP decreased from 31.0+/-5.7 (range, 25-43) mm Hg with 0.6+/-0.9 (range, 0-2) hypotensive medications to 15.5+/-2.6 mm Hg (range, 12-19) with 0.9+/-1.1 medications (range, 0-3), 11.3+/-4.9 months (range, 8-23) after the only or second (last) needling (P=0.012). In all eyes, the filtering bleb became diffused; in 7 eyes, it remained diffusely elevated or shallow-diffused.

Relatively few needle revisions of the filtering bleb by a modified approach that bypassed the activated scarring tissue contributed to the restoration of IOP control. It is possible that the 5-FU-needle revision may offer advantages over the standard approach. A larger sample and a controlled study are required to validate these considerations.