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High dose versus low dose Mitomycin-C assisted bleb needling in failing trabeculectomy blebs: a prospective
Kirti Singh1, Sanchita Mehta2, Annu Joon1
1Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, 110002, India.
Purpose:
To compare the safety and efficacy of high dose versus low dose Mitomycin-C (MMC) for bleb needling in failing trabeculectomy blebs.
Methods:
Patients (> 18 years) who did not achieve target intraocular pressure (IOP) and/or required anti glaucoma medications (AGMs) post trabeculectomy were recruited in this prospective, comparative, interventional study between December 2023-January 2025. MMC augmented bleb needling was performed with random allocation of patients to Group A (high dose MMC-60 μg) and Group B (low dose MMC-20 μg). Primary outcome was "complete success" (IOP 6-18 mmHg or IOP reduction > 20% without AGMs) and "qualified success" (criteria for complete success achieved with AGMs). Secondary outcome included bleb morphological changes on anterior segment optical coherence tomography (ASOCT), factors associated with success and complication rate.
Results:
A total of 54 patients underwent MMC augmented bleb needling (27 in each group). Baseline parameters were comparable between the groups. IOP decreased significantly from baseline (Group A-26.9 ± 5.3 mmHg; Group B-27.0 ± 4.9 mmHg) to 6 months (Group A -13.39 ± 2.6 mmHg; Group B-13.62 ± 1.7 mmHg) in both the groups and was maintained at 1 year (Group A: 12.72 ± 1.69 mmHg; Group B: 12.61 ± 1.89 mmHg). Complete success was higher in Group A compared to Group B (44.4% vs. 18.5%; p = 0.04) at 6 months and 1 year (35% vs. 5%; p = 0.04). Bleb assessment on ASOCT revealed decrease in internal reflectivity of bleb wall, and increase in bleb wall height and bleb wall thickness. Adverse events included subconjunctival hemorrhage (68.5%; n = 37/54), hypotony (3.7%; n = 2/54), hyphema (3.7%; n = 2/54) and conjunctival buttonhole (1.85%; n = 1/54) which were comparable between the two groups.
Conclusion:
Bleb needling with high dose MMC is a safe and effective measure for reviving failing trabeculectomy blebs with no added adverse outcomes when compared to low dose MMC. ASOCT effectively correlates bleb structure changes with post-operative IOP control.
