The aim of this study was to determine the efficacy of needling with 5-FU after failed filtering procedures in the paediatric population. This was a retrospective review of 324 filtration surgeries in 265 children with 55 eyes (16.9%) undergoing needling for failed blebs. Forty-five eyes of 40 children met the study criteria and were included. Mean age was 9.6 ±5.08 years; 80% male and 87.5% unilateral. Visual acuity preoperatively ranged from 6/9 to light perception only. Mean time interval between surgery and first needling was 57.3 days (range seven days to 17 months); 84.4% within three months of surgery. Mean follow-up after surgery was 18.9 months. Complete and qualified success rates were 48.8% and 28.8% respectively. Twenty-nine eyes required single needling, 13 eyes needed two and three eyes needed three. Mean IOP was 31.7mmHG pre needling reducing to 16.6 after one year for all patients. At one year follow-up, visual acuity improved to mean 1.14 logMAR. The number of antiglaucoma medications reduced from a mean of 2.69 to 0.58 after needling. There were nine complications of needling in seven eyes including mild hyphema in four, transient inferior choroidal detachment in one, persistent hypotony in one, and scattered preretinal haemorrhages in one. All were treated conservatively. The authors recommend a low threshold for performing needling because medications alone have less efficacy and suggest needling should be attempted as early as possible after noticing a failed bleb. Risk factors for failed needling include steroid induced glaucoma and higher baseline intraocular pressure. They recommend caution for needling in aphakic patients.
Needling procedure for failed bleb
Reviewed by Fiona Rowe
Outcome of bleb needling with 5-fluorouracil in failed filtering procedures in pediatric glaucoma.
CONTRIBUTOR
Fiona Rowe (Prof)
Institute of Population Health, University of Liverpool, UK.
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