[Late needling with 5-fluorouracil when scarring of filtering bleb seems imminent]

Evaluation of needling and 5-fluorouracil (5-FU) injections more than 4 months after preceding filtration surgery.

Retrospective analysis of 17 eyes in 14 patients who underwent needling of the filtering bleb and administration of 5-FU by injection at least 4 months after trabeculectomy (TE) with mitomycin C (MMC; same surgeon throughout). Complete success was defined as a reduction of intraocular pressure (IOP) by >30% from the baseline value without further medication and, in cases of primary open-angle glaucoma, IOP of 18 mmHg. The mean period of follow-up was 8.1 months (3-24 months).

One to four needlings (Ø 1.6) with one to five injections (Ø 3.1) of 5-FU were performed as required according to clinical need an average of 31.3 months (4-108 m) after TE. The mean baseline IOP was 25 mmHg (+/-SD 6.02; median 25 mmHg). After needling and 5-FU injection the mean IOD at the last hospital visit was 13.64 mmHg (+/-SD 5.2, median 13 mmHg; p<0,001). Complete success was achieved in 82.4% of these cases. The mean reduction in IOP was 11.2 mmHg (0-22 mmHg). In the cases with successful outcome (14 of 17 eyes) the mean IOP reduction from baseline was 55%. Three eyes required further treatment. Complications encountered were hyphaema (2 cases), subconjunctival bleeding (1 case) and corneal erosion (3 cases).

Late needling and injections of 5-FU can restore filtering bleb function even over 4 months after initial surgery. The high success rate and low incidence of complications together with the simple procedure justify regarding this approach as an alternative that can be used before passing on to more invasive interventions.