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Abstract #10209 Published in IGR 6-1
Needle revision of failing and failed trabeculectomy blebs with adjunctive 5-fluorouracil: survival analysis
Broadway DC; Bloom PA; Bunce C; Thiagarajan M; Khaw PTOphthalmology 2004; 111: 665-673
PURPOSE: To report the outcome of 5-fluorouracil (5-FU)-augmented bleb needling revision of failed and failing filtration blebs and to identify risk factors for failure, indicators for success, and any complications of the procedure. DESIGN: Prospective, observational, noncomparative, interventional case series with survival analysis. METHODS: The results of 101 bleb needling procedures augmented with subconjunctival 5-FU injection were determined after a minimum follow-up of nine months. Kaplan-Meier plots were constructed and a Cox proportional hazards regression analysis was performed to assess the association between study factors and time to failure. MAIN OUTCOME MEASURES: Reduction in intraocular pressure (IOP) by two criteria (< 22 mmHg, > 30%), glaucoma medications, complications, and factors associated with outcome. RESULTS: At the time of their last follow-up visit, 60 eyes had an IOP of < 22 mmHg, mean IOP being reduced from 26.5 to 18 mmHg after a median of one needling procedure (mean, 1.6). The median interval between the 'index' filtration surgery and the first (or only) needling procedure was 3.1 months, with a range of ten days to 11 years. There was a reduction in mean number of topical antiglaucoma agents from 0.7-0.2 per successful eye and a median follow-up duration of 18.7 months (range, 9.3-52.0 months). Thus, the overall cross-sectional success rate of the procedure at the time of the last visit was 59.4%. Strong evidence was found for an association between the immediate attainment of a low IOP (< 11 mmHg) and longer survival times. None of the other proposed factors that may have affected outcome were identified as having a statistically significant effect; however, this may have been the result of the low statistical power for some of the factors in this study. CONCLUSIONS: These data suggest that bleb needling augmented with 5-FU is a safe and effective method by which a significant number of failed or failing filtration blebs can be rescued from failure. Attaining an immediate reduction in IOP to < 11 mmHg seems to be a favorable factor with respect to reasonably long-term efficacy.
Dr. D.C. Broadway, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk NR4 7UZ, UK. david.broadway@nnuh.nhs.uk
Classification:
12.8.11 Complications, endophthalmitis (Part of: 12 Surgical treatment > 12.8 Filtering surgery)