Needling revision with subconjunctival 5-fluorouracil in failing filtering blebs

5-Fluorouracil, an antimetabolic agent, improves the success rate of trabeculectomies by inhibiting subconjunctival fibrosis. However, complications may be associated with early postoperative use. We investigated the outcome of needling revision with delayed subconjunctival 5-fluorouracil in failing filtering blebs after a trabeculectomy in patients with medically poorly controlled glaucoma.

We performed needling revision with subconjunctival 5-fluorouracil injection 5.0 +/- 4.0 weeks after trabeculectomy with failing filtering blebs in 25 eyes of 24 patients. The diagnoses of these patients were primary angle-closure glaucoma (4), primary open-angle glaucoma (4), post-cornea-graft glaucoma (8), traumatic glaucoma (5), neovascular glaucoma (3) and pseudophakic glaucoma (1).

Total success was achieved in 21 eyes (84%) including complete success in 10 (40%) and qualified success in 11 (44%) after 3.2 +/- 1.2 needling revisions over an average 8.3 +/- 7.0-month follow-up period from the last needling revision. The mean intraocular pressure was 16.0 +/- 8.4 mmHg in the last visit compared with 26.0 +/- 8.1 mmHg before the procedure. Major complications were transient hypotony (1), transient corneal epithelial defect (13) and hyphema (3).

This study supports the efficacy and safety of the delayed use of 5-fluorouracil with needling revision for managing failing filtering blebs following a trabeculectomy.