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Clinical Outcomes of Index Needle Revision for Failed Deep Sclerectomy in Vietnamese Eyes
Nguyen Thi Thuy Giang1,2, Bui Thi Van Anh2,3, Pham Trong Van1
1Department of Ophthalmology, Hanoi Medical University, Hanoi, Vietnam.
Objectives:
To evaluate the clinical outcomes of our index needle revision with subconjunctival 5-fluorouracil (5-FU) injection for failed non-penetrating deep sclerectomy (NPDS) in Vietnamese patients.
Methods:
This prospective study included eyes with failed NPDS that underwent 5-FU-augmented needle revision between 2023 and 2025. Complete and qualified success rates were evaluated at 6 and 12 months postoperatively. Factors potentially associated with procedure success were analyzed.
Results:
A total of 41 eyes of 33 patients with failed NPDS underwent first needle revision augmented with 5-fluorouracil. The mean patient age was 46.09 ± 16.7 years. Mean pre-needling intraocular pressure (IOP) was 27.66 ± 6.84 mmHg, which was reduced to 14.05 ± 3.22 mmHg, 14.56 ± 5.35 mmHg, and 14.10 ± 3.72 mmHg at 3, 6, and 12 months, respectively (p < 0.001). Best-corrected visual acuity showed a minimal change from 0.67 ± 0.76 preoperatively to 0.65 ± 0.77 at 12 months. Complete and qualified success rates were 78.1% at 6 months, and 68.3% and 70.7%, respectively, at 12 months. Postoperative complications included subconjunctival hemorrhage in 33 eyes (80.5%), hyphema in 4 eyes (9.8%), shallow or flat anterior chamber in 10 eyes (24.4%), corneal epithelial toxicity in 6 eyes (14.6%), iris incarceration in 2 eyes (4.8 %), and hypotony in 4 eyes (9.8%), all occurring in eyes with prior mitomycin C exposure. No cases of endophthalmitis were observed. No significant associations were found between surgical success and patient age, history of previous needle revision, or prior laser goniopuncture, or the interval between the first needle revision and surgery.
Conclusion:
First-time needle revision augmented with 5-fluorouracil demonstrated satisfactory effectiveness in restoring bleb function in failed NPDS, with an acceptable and predictable safety profile. Most complications were self-limited. Particular caution is recommended when revising thin, avascular blebs, which may be more susceptible to postoperative hypotony.