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Abstract #18284 Published in IGR 3-3
Risk factors for failure of 5-fluorouracil needling revision for failed conjunctival filtration blebs
Shin DH; Kim YY; Ginde SY; Kim PH; Eliassi-Rad B; Khatana AK; Keole NSAmerican Journal of Ophthalmology 2001; 132: 875-880
PURPOSE: To investigate the risk factors for failure of 5-fluorouracil (5-FU) needling revision, a useful procedure for restoring a failed filtration bleb. DESIGN: Interventional case series. METHODS: Retrospectively conducted study.SETTING: Institutional. STUDY POPULATION: Sixty-four eyes of 64 consecutive glaucoma patients that underwent 5-FU needling revisions for failed filtering bleb following either trabeculectomy or phaco-trabeculectomy with or without adjunctive mitomycin C (MMC). OBSERVATION PROCEDURES: Goldmann applanation tonometry, Kaplan-Meier survival analysis, and Cox proportional hazards regression analysis. MAIN OUTCOME MEASURES: Successful outcome of the initial 5-FU needling revision, arbitrarily defined as target intraocular pressure (IOP) control with not more than two topical glaucoma medications and no additional 5-FU needling or other surgical procedures, was analyzed by Kaplan-Meier survival analysis, and risk factors for failure of the initial 5-FU needling revision were analyzed by Cox proportional hazards regression analysis. RESULTS: The cumulative success rate of the initial 5-FU needling revision was 45% at one year, 33% at two years, and 28% at four years. Failure of the initial 5-FU revision correlated significantly with preneedling IOP > 30 mmHg (p = 0.0003), lack of MMC use during the previous filtration surgery (p = 0.013), and IOP >10 mmHg immediately following needling revision (p = 0.0012) according to Cox's proportional hazards regression analysis. CONCLUSIONS: Pre-needling IOP > 30 mmHg, lack of MMC use during the previous filtration surgery, and IOP > 10 mmHg immediately after needling were found to be significant risk factors for failure of the initial 5-FU needling procedure. Therefore, it is important to monitor IOP closely following needling revision in those patients with such risk factors. They are more likely to require additional therapeutic interventions, including repeat needling revisions.
Dr D.H. Shin, Kresge Eye Institute Wayne State University School of Medicine, Detroit, MI, USA
Classification:
12.8.10 Woundhealing antifibrosis (Part of: 12 Surgical treatment > 12.8 Filtering surgery)