NEEDLE REVISION WITH MITOMYCIN-C IN ENCAPSULATED BLEBS

The most common cause of failure during the first trimester after trabeculectomy isencapsulated bleb and needling bleb revision is a less invasive method in the management of refractorycases. the purpose of this before-after (paired) observation study was to determine the efficacy andsafety of mitomycin-c (mmc) augmented bleb revision of failed filtration surgery. a total of 33patients with failed trabeculectomy because of bleb encapsulation, whose intraocular pressure (iop)was not reduced under 21 mmhg despite medication and digital massage, underwent needling blebrevision and subconjunctival injection of 0.1 ml mmc (0.4 mg/ml). the mean follow-up time was 9.24± 5.27 months (1-20 months). statistical analysis of the data included the paired two-tailed student’s ttest for preoperative and postoperative iop and number of medications. a total of 36 needlingprocedures were performed on 33 eyes. patients were between 10-80 years old (mean, 45.67 ± 22.41years) and mean follow-up was 9.24 ± 5.27 months. iop decreased from 29.06 ± 5.03 mmhg to 18.21 ±6.76 mmhg at last follow-up (p= 0.000). antiglaucoma medications decreased from 2.18 ± 0.58 to 1.36± 0.29 at last follow-up (p= 0.000). overall, 6 (18.2%) of 33 cases achieved a complete success and 20(60.6%) of cases achieved a qualified success. the complications of this procedure weresubconjunctival hemorrhage (17 cases), hyphema (5 cases) and conjunctival button hole (2 cases).needling bleb revision with mitomycin-c appears to be an effective and relatively safe way to revivefailed filtration surgery.