The Efficacy of 5-Fluorouracil Bleb Needling Performed 1 Year or More Posttrabeculectomy

Abstract

To determine the efficacy of a subconjunctival needling revision using 5-fluorouracil (5FU) when administered to patients who have nonfiltering, flat, or encapsulated blebs over 1 year after the original surgery. The charts of 37 glaucoma patients, who had undergone both a trabeculectomy filtering procedure and a subconjunctival 5FU needling revision, with a minimum interval of 1 year between these procedures and with no intervening surgical procedures, were retrospectively reviewed. The needling was a clinic procedure using a 30-gauge needle and 0.1 mL of 50 mg/mL 5FU. Intraocular pressure (IOP) decreased by an average of 10.5 mm Hg (44.8%) immediately after the needling procedure. Eleven eyes (29.7%) achieved absolute success, defined as IOP control with no further needling revision, surgical intervention, or antiglaucoma medication in the 2-year follow-up period. Thirteen eyes (35.1%) achieved a qualified success, defined as IOP control with resumed medication use, undergoing a laser procedure, or a repeat needling within the follow-up period. Thirteen eyes (35.1%) failed the procedure by requiring a repeat surgical intervention. The mean IOP was 16.3+/-4.6 mm Hg in the success group, 15.5+/-6.5 mm Hg in the qualified success group, and 27.7+/-8.9 mm Hg in the failure group at the end of follow-up. Late 5FU needling is an effective method to control IOP and avoid further surgery in a high proportion of patients with medically uncontrolled nonfiltering blebs.