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1 General aspects (0)   1.1 Epidemiology (6)   1.2 Population genetics (0)   1.3 Pathogenesis (0)   1.4 Quality of life (13)   1.5 Glaucomas as cause of blindness (5)   1.6 Prevention and screening (3) 2 Anatomical structures in glaucoma (0)   2.1 Conjunctiva (5)   2.2 Cornea (19)   2.3 Sclera (11)   2.4 Anterior chamber angle (3)   2.5 Meshwork (0)     2.5.1 Trabecular meshwork (10)     2.5.2 Schlemms canal (1)     2.5.3 Scleral outlet channels (0)   2.6 Aqueous humor dynamics (0)     2.6.1 Production (0)     2.6.2 Outflow (0)       2.6.2.1 Trabecular meshwork (1)       2.6.2.2 Uveoscleral (0)     2.6.3 Compostion (6)   2.7 Episcleral veins and venous pressure (0)   2.8 Iris (6)   2.9 Ciliary body (0)   2.10 Lens (0)   2.11 Vitreous body (1)   2.12 Choroid, peripapillary choroid, peripapillary atrophy (15)   2.13 Retina and retinal nerve fibre layer (17)   2.14 Optic disc (28)   2.15 Optic nerve (0)   2.16 Chiasma and retrochiasmal central nervous system (5)   2.17 Stem cells (4)   2.20 Other (0) 3 Laboratory methods (0)   3.1 Microscopy (0)   3.2 Electron microscopy (0)   3.3 Immunohistochemistry (2)   3.4 Molecular genetics (0)     3.4.1 Linkage studies (0)     3.4.2 Gene studies (18)   3.5 Molecular biology incl. SiRNA (20)   3.6 Cellular biology (42)   3.7 Biochemistry (14)   3.8 Pharmacology (25)   3.9 Pathophysiology (26)   3.10 Immunobiology (10)   3.11 Pharmacogenetics (0)   3.12 Proteomics (1)   3.13 In vivo imaging (0)     3.13.1 Laser Scanning (0)       3.13.1.1 Confocal Scanning Laser Ophthalmoscopy (0)       3.13.1.2 Confocal Scanning Laser Polarimetry (0)     3.13.2 Optical Coherence Tomography (0)       3.13.2.1 Anterior Segment (0)       3.13.2.2 Posterior Segment (0)     3.13.3 RGC Imaging (0)     3.13.4 Other (1)   3.20 Other (0) 4 Tissue culture of ocular cells (0) 5 Experimental glaucoma; animal models (1)   5.1 Rodent (28)   5.2 Primates (0)   5.3 Other (8) 6 Clinical examination methods (1)   6.1 Intraocular pressure measurement; factors affecting IOP (1)     6.1.1 Devices, techniques (18)     6.1.2 Fluctuation, circadian rhythms (16)     6.1.3 Factors affecting IOP (9)   6.2 Tonography, aqueous flow measurement (see also 2.6) (0)   6.3 Biomicroscopy (slitlamp) (0)     6.3.1 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disorders (0)     9.4.1 Steroid-induced glaucoma (2)     9.4.2 Glaucomas associated with disorders of the cornea, conjunctiva, sclera (1)       9.4.2.1 Iridocorneal endothelial syndrome (ICE, incl. irisatrophy) (1)       9.4.2.2 Posterior polymorphous dystrophy (0)       9.4.2.3 Fuchs' endothelial dystrophy (0)       9.4.2.5 Other (1)     9.4.3 Glaucomas associated with disorders of the iris and ciliary body (0)       9.4.3.1 Pigmentary glaucoma (2)       9.4.3.5 Other (0)     9.4.4 Glaucomas associated with disorders of the lens (0)       9.4.4.1 Exfoliation syndrome (22)       9.4.4.2 Glaucomas associated with cataracts (1)       9.4.4.3 Glaucomas associated with lens dislocation (1)       9.4.4.5 Other (1)     9.4.5 Glaucomas associated with disorders of the retina, choroid and vitreous (0)       9.4.5.1 Neovascular glaucoma (9)       9.4.5.5 Other (7)     9.4.6 Glaucomas associated with inflammation, uveitis (7)     9.4.7 Glaucomas associated with ocular trauma (2)     9.4.8 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Prostaglandins (13)   11.5 Carbonic anhydrase inhibitors (0)     11.5.1 Systemic (2)     11.5.2 Topical (3)   11.6 Osmotic treatment (1)   11.7 Treatment of bloodflow (0)   11.8 Neuroprotection (34)   11.9 Gene therapy (1)   11.13 Combination therapy (2)     11.13.1 Betablocker and pilocarpine (0)     11.13.2 Betablocker and carbon anhydrase inhibitor (0)     11.13.3 Betablocker and brimonidine (0)     11.13.4 Betablocker and prostaglandin (2)     11.13.5 Other (2)   11.14 Investigational drugs; pharmacological experiments (2)   11.15 Other drugs in relation to glaucoma (7)   11.16 Vehicles, delivery systems, pharmacokinetics, formulation (19)   11.17 Cooperation with medical therapy e.g. persistency, compliance, adherence (11)   11.20 Other (1) 12 Surgical treatment (1)   12.1 General management, indication (0)   12.2 Laser iridotomy (0)   12.3 Laser iridoplasty (0)   12.4 Laser trabeculoplasty and other laser treatment of the angle (6)   12.7 Surgical iridectomy (2)   12.8 Filtering surgery (1)     12.8.1 Without tube implant (15)     12.8.2 With tube implant or other drainage devices (46)     12.8.3 Non-perforating (4)     12.8.4 Using laser (1)     12.8.5 Other (1)     12.8.10 Woundhealing antifibrosis (12)     12.8.11 Complications, endophthalmitis (11)   12.9 Trabeculotomy, goniotomy (8)   12.10 Cyclodestruction (9)   12.11 Cyclodialysis (0)   12.12 Cataract extraction (0)     12.12.1 Intracapsular (0)     12.12.2 Extracapsular (0)     12.12.3 Phacoemulsification (8)   12.14 Combined cataract extraction and glaucoma surgery (0)     12.14.1 Intracapsular (0)     12.14.2 Extracapsular (0)     12.14.3 Phacoemulsification (4)   12.15 Capsulotomy (0)   12.16 Vitrectomy (4)   12.17 Anesthesia (1)   12.20 Other (2) 13 Therapeutic prognosis and outcome (0)   13.1 Prognostic factors (0)   13.2 Outcome (0)     13.2.1 IOP (0)     13.2.2 Visual field (0)       13.2.2.1 Progression (0)       13.2.2.2 Improvement (1)     13.2.3 Other (0) 14 Costing studies; pharmacoeconomics (6) 15 Miscellaneous (28)

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Abstract #86860 Published in IGR 21-2

Needling after trabeculectomy - does augmentation by anti-metabolites provide better outcomes and is Mitomycin C better than 5-Fluoruracil? A systematic review with network meta-analyses

Halili A; Kessel L; Subhi Y; Bach-Holm D
Acta Ophthalmologica 2020; 98: 643-653

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PURPOSE: Favourable outcome after glaucoma surgery depends on proper control of the inflammatory response. Failing filtration bleb and consequently increased intraocular pressure is an important cause of continuous visual field deterioration after uncomplicated glaucoma surgery. The present systematic review and meta-analysis aimed to compare the effects of employing either Mitomycin C (MMC), 5-Fluoruracil (5-FU) or no anti-metabolite in needling revision of trabeculectomies. METHODS: We performed a systematic literature search in PubMed, Cochrane and EMBASE to identify randomized and non-randomized trials published between year 2000 and March 2019 comparing the efficacy of needling filtering blebs when using no anti-fibrotic agent, MMC or 5-FU in patients with glaucoma. Efficacy was defined as intraocular pressure at 12 months or latest follow-up, rate of complications, rates of success and the number of re-needling cases. Comparisons were made using network meta-analyses. RESULTS: We identified one randomized trial and five retrospective trials. Twelve months after needling revision of trabeculectomy, no significant difference was observed when comparing the effect of the use of MMC with 5-FU or without any use of anti-metabolite on intraocular pressure, complication rates, qualified success, complete success or number of re-needling cases. CONCLUSION: We found no significant difference in the efficacy of using either MMC, 5-FU or no anti-metabolite in needling revision of trabeculectomies. The number of studies meeting our inclusion criteria was limited. Considering the design of studies, only one was randomized leading to an overall low quality of evidence on the subject matter. Further research is warranted.

Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark.

Full article

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Classification:

12.8.1 Without tube implant (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
12.8.10 Woundhealing antifibrosis (Part of: 12 Surgical treatment > 12.8 Filtering surgery)

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