Long-term outcomes of needle revision of failing deep sclerectomy blebs

To report on long-term outcomes of mitomycin C (MMC)-augmented needle revision of failing deep sclerectomy (DS) blebs.

Retrospective database search of all needle revisions with MMC for DS blebs between 2002 and 2008 was conducted. Sixty-six eyes of 66 patients were included in the study. Subconjunctival MMC 0.01-0.02 mg was injected 15 min before needle revision. Complete success was defined as intraocular pressure ≤ 18 mmHg or 20% decrease from baseline with no glaucoma medications or further surgical procedures. Partial success was based on the same criteria, but with medications.

Mean follow-up after index needle revision was 67.8 ± 24.8 months (range 1-10 years). The mean number of needle revisions was 1.6 ± 0.8 (range 1-4). Two or more procedures were done in 31 eyes (47.0%). Mean preoperative intraocular pressure was 23.2 ± 6.9 mmHg. Complete and partial success rates were 64% and 71% at 1 year, 57% and 68% at 3 years, and 40 % and 58 % at 5 years after surgery, respectively. Early needle revision, within 6 months of index surgery, was significantly associated with failure, both on uni- and multivariate tests. Significant complications included delayed hypotony in five eyes (7.6%), delayed bleb leak in two eyes (3.0%), endophthalmitis in one eye (1.5%), and corneal oedema in two eyes (3.0%).

Needle revision with subconjunctival MMC may successfully lower the intraocular pressure in eyes with a failing DS bleb in the long term. Complications known to be associated with trabeculectomy and MMC were anticipated and observed in our DS group.