Long-Term Outcomes from an Intraoperative Bleb Needling Procedure Augmented with Continuous Infusion

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Surgical Techniques

Background:

• Trabeculectomy is a common glaucoma surgery, but its success can decrease over time.
• Failed trabeculectomy may require repeat surgery or alternative procedures like tube shunts.
• Bleb needling is a minimally invasive technique to improve filtration after glaucoma surgery.

Purpose of the Study:

• To evaluate the long-term effectiveness of a modified intraoperative bleb needling technique in controlling intraocular pressure (IOP).
• To identify risk factors associated with failure of the bleb needling procedure.
• To assess the safety and durability of bleb needling in patients with previously failed glaucoma surgery.

Main Methods:

• A retrospective, observational cohort study of 106 eyes from 98 patients who underwent modified bleb needling.
• Patients had a history of failed trabeculectomy or express shunt surgery.
• Success was defined by achieving target IOP with or without glaucoma medications; patients requiring further surgery were censored.

Main Results:

• A 70% qualified success rate at 1 year and 52% at 5 years, with mean IOP reductions of 25% and 44.3%, respectively.
• Significant reduction in glaucoma medication use was observed long-term.
• Poorer outcomes were associated with Black patients, but not bleb age; complications were uncommon.

Conclusions:

• Modified bleb needling provides sustained IOP reduction long-term in patients with prior failed glaucoma surgery.
• This technique is safe and effective, potentially delaying or avoiding more invasive glaucoma surgeries.
• Bleb needling offers a valuable option for managing refractory glaucoma.