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Restoring the function of the failed bleb.

W E Gillies¹, A M Brooks

¹Glaucoma Investigation and Research Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.

Australian and New Zealand Journal of Ophthalmology

|February 1, 1991

Summary

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Needling a filtering bleb with 5-fluorouracil effectively lowers intraocular pressure (IOP) in glaucoma patients. This procedure is a rapid intervention for bleb encapsulation, flattening, or cystoid formation, restoring IOP control.

Area of Science:

Ophthalmology
Glaucoma Surgery
Surgical Complications

Background:

Filtering bleb failure after trabeculectomy can result from encapsulation, flattening, or cystoid formation.
Elevated intraocular pressure (IOP) is often associated with encapsulated and flattened blebs.
Cystoid blebs may necessitate revision due to risks like corneal ulceration.

Purpose of the Study:

To evaluate the efficacy of bleb needling with 5-fluorouracil in managing filtering bleb failure post-trabeculectomy.
To assess IOP control in patients with different types of bleb complications.

Main Methods:

A retrospective analysis of sixteen patients undergoing bleb needling with 5-fluorouracil.
Patients were categorized by bleb type: encapsulated (8), flattened (6), and cystoid (2).

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Intraocular pressure (IOP) was measured before and after the needling procedure.

Main Results:

Satisfactory IOP control was achieved in twelve patients.
Mean pre-needling IOP for encapsulated blebs was 32 mmHg, reduced to 12 mmHg post-needling.
Mean pre-needling IOP for flattened blebs was 36 mmHg, reduced to 13 mmHg post-needling. Mean pre-needling IOP for cystoid blebs was 16 mmHg, reduced to 12 mmHg post-needling.

Conclusions:

Bleb needling with 5-fluorouracil is an effective treatment for restoring IOP control in cases of filtering bleb failure.
The procedure demonstrated significant IOP reduction across encapsulated, flattened, and cystoid bleb morphologies.
Needling offers a timely intervention for managing bleb-related complications following glaucoma surgery.