Clinical Study Of Needle Revision Combined With 5-FU Subconjunctival Injection For Dysfunctional Filtering Blebs

OBJECTIVE: To study the safety and efficacy of needle revision combined with 5-FU subconjunctival injection at early or middle stage dysfunctional filtering blebs. To analyze factors affecting the effect of needling.METHODS: From March 2008 to June 2010 in Shandong Provincial Hospital, 23 patients(23eyes) who had poor bleb morphology and poorly controlled intraocular pressure at early or middle stage after trabeculectomy were given needle revision combined with 5-FU subconjunctival injection. Under operating microscope,0.1ml syringe needle was used for needling. After needling,5-FU 0.2ml (25mg/ml) was injected into subconjunctival around the bleb at two sites. Tobramycin ophthalmic solution (tobradex) was given 4 times a day. Patients were followed up after 1 week,2 weeks,4 weeks,8 weeks,16 weeks,20 weeks,24 weeks. The intraocular pressure, bleb morphology and complications were observed and recorded. Intraocular pressure and filtering bleb survival were analyzed. Factors affecting effect of needling such as previous history of eye surgery, bleb appearance before needling and immediately intraocular pressure after the needling were analyzed.RESULTS:To judge as following criterias:1.Total effective:no use of any intraocular pressure-lowering eye drops, intraocular pressure less than 21mmHg.2. Partial effective:application of one intraocular pressure-lowering eye drops, intraocular pressure less than 21mmhg.3. Failure:the need for two or more intraocular pressure-lowering eye drops, regardless of normal intraocular pressure or not. Preoperative intraocular pressure was 21.9-35mmHg, average 26.5mmHg±3.0, whereas postoperative intraocular pressure was 7.7-18.5mmHg, average 12.6mmhg±5.9. There were 7 cases whose intraocular pressure higher than 21mmHg in spite of using two intraocular pressure-lowering drops during follow-up. The last intraocular pressure of all 23 eyes was 10.10-38.OmmHg, average 20.5mmHg±8.20. There were 16 functional filtering blebs and 7 non-functional blebs at the end of follow-up. Bleb survival curve analysis showed that the bleb survival rate was 69.6±0.9% in the 24th week after needling. The average survival time of 23 blebs was 20.52 weeks±1.26, 95% confidence interval was 18.05-22.99 weeks. Needling complications:shallow anterior chamber and ocular hypotension after needing was 8 eyes, subconjunctival hemorrhage occurred in 4 eyes, iritis observed in 3 eyes, hyphema occurred in 2 eyes. Statisticaly, there were no significant difference between needling effect and previous history of eye surgery, immediately intraocular pressure after needling and interval of trabeculectomy to needling, while there was significant difference between effect of needling and bleb appearance.CONCLUSIONS:The needle revision combined 5-FU injection is an effective treatment for failure bleb. It is a simple, safe and repeatable method. Surgical equipment for this method is not complicated. Statisticaly, there was significant difference between effect of needling and bleb appearance. Needling effect of encapsulating-like bleb was better than that of flatten-like bleb.