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Editors Selection IGR 10-3

Surgical Treatment: Needling with 5FU and bleb morphology

Comment by Ike Ahmed on:

21716 Needling revision of trabeculectomies bleb morphology and long-term survival, Rotchford AP; King AJ, Ophthalmology, 2008; 115: 1148-1153

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A number of studies have attempted to assess the success rate and predictive factors of needling of failing filtering blebs. Rotchford and King (1234) attempt to prospectively determine the medium-term success of needling with 5-fluorouracil, and the factors that predict success, with a particular emphasis on pre- needling bleb morphology. Success rate over 48 months (although most patients only had 24 month data), was somewhat low ‐ and expected ‐ with only a 45.7% surviving at two years. Pre- needling elevated blebs achieved higher success rate than flat blebs. Elevated blebs needled within three months, with presence of microcysts and bleb vascularization were most likely to survive. Survival time was shorter if multiple needlings were required, or in an immediate IOP to ≤ 10 mmHg was not achieved.

The results of this paper seems to support those find in other studies ‐ that although needling a failing filter may resurrect function, for the majority, it only delays the potential need for further surgery. When needling, clinicians should attempt to lower IOP immediately to ≤ 10mmHg to enhance success, and expect those patients with a flat bleb to have a reduced likelihood of success. Timing of needling did not appear to provide a benefit in the long term.

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