Bleb needle redirection for the treatment of early postoperative trabeculectomy leaks: a novel approach

This study describes a technique of bleb needling as a management of early postoperative limbal bleb leaks unresponsive to conservative management. This technique redirects the aqueous into a newly formed bleb, sealing the leak easily and rapidly.

Medical records of patients with early bleb leaks after trabeculectomy or phacotrabeculectomy between November 2004 and September 2005 were reviewed retrospectively. Patients whose bleb leaks were unresponsive to conservative management and who underwent needling procedures were identified and studied further.

Six of 18 patients who had early bleb leaks did not respond to conservative treatment and underwent a needle redirection of their blebs, which sealed within a few days after needling. The mean follow-up time of this group was 6 months. The mean preoperative vision was 20/50 with a mean preoperative intraocular pressure (IOP) of 27 using 2.8 medications, and this improved postoperatively and postneedling to a vision of 20/30 with a mean IOP of 11 using 0.16 medications.

Bleb needling with subsequent redirection of aqueous into a new bleb should be considered as an option in the treatment of limbal leaks after a trabeculectomy that does not respond to conservative treatment.