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Long-term outcomes of needle revision of failing deep sclerectomy blebs

  • Glaucoma
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To report on long-term outcomes of mitomycin C (MMC)-augmented needle revision of failing deep sclerectomy (DS) blebs.

Methods

Retrospective database search of all needle revisions with MMC for DS blebs between 2002 and 2008 was conducted. Sixty-six eyes of 66 patients were included in the study. Subconjunctival MMC 0.01–0.02 mg was injected 15 min before needle revision. Complete success was defined as intraocular pressure ≤ 18 mmHg or 20 % decrease from baseline with no glaucoma medications or further surgical procedures. Partial success was based on the same criteria, but with medications.

Results

Mean follow-up after index needle revision was 67.8 ± 24.8 months (range 1–10 years). The mean number of needle revisions was 1.6 ± 0.8 (range 1–4). Two or more procedures were done in 31 eyes (47.0 %). Mean preoperative intraocular pressure was 23.2 ± 6.9 mmHg. Complete and partial success rates were 64 % and 71 % at 1 year, 57 % and 68 % at 3 years, and 40 % and 58 % at 5 years after surgery, respectively. Early needle revision, within 6 months of index surgery, was significantly associated with failure, both on uni- and multivariate tests. Significant complications included delayed hypotony in five eyes (7.6 %), delayed bleb leak in two eyes (3.0 %), endophthalmitis in one eye (1.5 %), and corneal oedema in two eyes (3.0 %).

Conclusions

Needle revision with subconjunctival MMC may successfully lower the intraocular pressure in eyes with a failing DS bleb in the long term. Complications known to be associated with trabeculectomy and MMC were anticipated and observed in our DS group.

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Conflicts of interest

There was no prior financial support and none of the contributing authors has any financial interest related to this manuscript.

None of the authors has conflict of interests with the submission.

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Authors and Affiliations

  1. Department of Ophthalmology, FRCOphth, Royal Free Hospital, Pond Street, NW3 2QG, London, UK

    Antigoni Koukkoulli

  2. FRCOphth, Calderdale & Huddersfield NHS Trust, Huddersfield Royal Infirmary, HD3 3EA, Huddersfield, UK

    Fayyaz Musa & Nitin Anand

Authors
  1. Antigoni Koukkoulli
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  2. Fayyaz Musa
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  3. Nitin Anand
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Correspondence to Antigoni Koukkoulli.

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Koukkoulli, A., Musa, F. & Anand, N. Long-term outcomes of needle revision of failing deep sclerectomy blebs. Graefes Arch Clin Exp Ophthalmol 253, 99–106 (2015). https://doi.org/10.1007/s00417-014-2810-4

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  • DOI: https://doi.org/10.1007/s00417-014-2810-4

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