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Editors Selection IGR 9-3

Surgical Treatment: Bleb needling

Comment by Sunita Radhakrishnan & Andrew Iwach on:

54218 5-Fluorouracil augmented needle revision of trabeculectomy: does the location of outflow resistance make a difference?, Tatham A; Sarodia U; Karwatowski W, Journal of Glaucoma, 2013; 22: 463-467

Find related abstracts

To determine if location of outflow resistance influences outcomes in bleb needling, Tatham et al. retrospectively analyzed two types of bleb needling ‐ 'Type-1' needling was limited to the subconjunctival-subTenon space and 'Type-2' needling additionally involved elevation of the scleral flap and was performed if subconjunctival needling did not result in bleb elevation. Thirtyfour eyes of 30 patients were evaluated ‐ 16 had Type-1 and 18 had Type-2 needling procedures and all were performed in the operating room (OR). The median interval between trabeculectomy and needling was relatively short at 124 days. The overall success rate of 82.4%, (including 47.1% complete and 35.3% qualified success) was similar to previously published data. Although there was no statistically significant difference in the success rates of Type-1 and Type-2 revisions, the authors noted that unqualified success was higher in Type-2 revisions (61% versus 31% in Type-1 revisions). Many surgeons who already perform scleral flap elevation in all cases of bleb needling regardless of the results of subconjunctival needling will find this data supportive. Most studies on bleb needling do not specify the anatomical location of outflow resistance and the study authors should be commended on a clear separation of two types of needling based on subconjunctival versus scleral flap resistance. As the authors acknowledge, the small sample size is a limitation. The authors caution against performing scleral flap elevation in all cases until data from prospective studies is available. However, in the authors' experience, this additional step, when performed in patients who undergo bleb needling in the OR and have a clearly visible flap, does not increase the risk of complications.

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