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Comparison of Efficacy and Safety of Bleb Needle Revision With and Without 5-Fluorouracil for Failing Trabeculectomy Bleb

Kim, Jin-Soo, MD*; Kim, Hae Jin, MD*,†; Na, Kyeong Ik, MD; Kim, Young Kook, MD*,§; Park, Ki Ho, MD, PhD*,§; Jeoung, Jin Wook, MD, PhD*,§

doi: 10.1097/IJG.0000000000001226
Original Studies
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Précis: Bleb needle revision with and without 5-FU showed similar success rates over the course of a long-term follow-up. A greater total number of needle revisions was identified as a risk factor for procedural failure.

Purpose: The purpose of the study was to investigate the efficacy and safety of bleb needle revision with adjunctive 5-fluorouracil (5-FU) subconjunctival injection in large-scaled patients with failing trabeculectomy bleb.

Materials and Methods: A retrospective chart review was performed on a total of 113 eyes of 106 subjects who had undergone trabeculectomy followed by needle revision and been followed up for at least 6 months. The subjects were divided into 2 groups according to whether they had also undergone concurrent adjunctive 5-FU subconjunctival injection. Two definitions of failure were derived irrespective of IOP-lowering medication use and were assessed at each follow-up visit: (1) IOP>21 mm Hg or >85% of preoperative IOP or reoperation for glaucoma, (2) IOP>18 mm Hg or >80% of preoperative IOP or reoperation for glaucoma.

Results: A total of 78 eyes of 73 subjects underwent the simple needle revision procedure and 35 eyes of 33 subjects underwent needle revision with subconjunctival 5-FU injection. There was no significant adverse event for either group and no significant IOP difference in any of the observational periods between them (P=0.867). There was also no statistically significant difference in the total number of IOP-lowering medications between the groups (P=0.199). The success rate at 24 months after the first needle revision was 45.6% (95% CI: 33.7, 56.7) in simple revision group and 44.6% (95% CI: 27.7, 60.2) in 5-FU needle revision group by failure 1, 36.3% (95% CI: 25.4, 47.2) and 32.9% (95% CI: 18.0, 48.6) by failure 2, respectively. A greater total number of needle revisions was the significant risk factors for needle revision failure (HR=2.25 and P=0.001 according to failure 2).

Conclusions: Bleb needle revision with 5-FU subconjunctival injection is a safe procedure for failing trabeculectomy bleb. Bleb needle revision with and without 5-FU were equally likely to succeed.

*Department of Ophthalmology, Seoul National University Hospital

§Department of Ophthalmology, Seoul National University College of Medicine, Seoul

Cheonan Kim’s Eye Clinic, The Head Office, Cheonan

Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea

J.-S.K. and H.J.K contributed equally.

Supported by a grant (14172MFDS178) from the Ministry of Food and Drug Safety in 2014.

Disclosure: The authors declare no conflict of interest.

Reprints: Jin Wook Jeoung, MD, PhD, Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (e-mail: neuroprotect@gmail.com).

Received November 25, 2018

Accepted February 7, 2019

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