Effect of Needle Revision of Failed Filtering Blebs with Different Concentrations of Mitomycin C

Kyeong Jin Woo; Sungmin Hyung

doi:10.3341/jkos.2008.49.6.951

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Woo and Hyung: Effect of Needle Revision of Failed Filtering Blebs with Different Concentrations of Mitomycin C

Original Article

J Korean Ophthalmol Soc 2008;49(6):951-957.

Published online: 8 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.6.951

Effect of Needle Revision of Failed Filtering Blebs with Different Concentrations of Mitomycin C

Kyeong Jin Woo, M.D., Sungmin Hyung, M.D., Ph.D.

Department of Ophthalmology, School of Medicine, Chungbuk National University, Chungbuk, Korea

Address reprint requests to Sungmin Hyung, M.D., Ph.D. Department of Ophthalmology, Chungbuk National University Hospital #410 Sungbongro, Heungduk-gu Cheongju, Chungbuk 361-711, Korea Tel: 82-43-269-6368, Fax: 82-43-264-5263, E-mail: smh@chungbuk.ac.kr

26 February 2008 Accepted 20 September 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the efficacy and the risk factors for failure and complications of mitomycin C (MMC)-augmented needle revision (NR) of failed filtering blebs.

Methods

Thirty eyes whose intraocular pressure (IOP) did not decrease after the cutting of scleral flap sutures were recruited. NR was performed with a 26-gauge needle under a slit-lamp. Immediately following NR, all eyes received a subconjunctival injection of 0.1 ml of 0.02 mg/ml (group A) or 0.1 mg/ml (group B) MMC at the adjacent conjunctiva. The mean follow-up period after the last needle revision was 13.2±4.2 months.

Results

The mean IOP decreased from 25.7±10.6 mmHg before surgery to 13.7±2.5 mmHg at the last follow-up in group A and from 24.1±6.8 mmHg to 17.7±8.6 mmHg in group B (group A: p=0.001, group B: p=0.065). Subconjunctival hemorrhage, hyphema, and a shallow anterior chamber appeared in most cases. However, choridal detachment and avascular changes of the conjunctiva were observed in group B.

Conclusions

IOP decreased in both groups A and B, but severe complications appeared only in group B. NR followed by a subconjunctival injection of 0.02 rather than 0.1 mg/ml is a safe and effective method.

Keywords: Filtering bleb, Mitomycin C, Needle revision

References

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Figure 1.

Pre‐ NR and post‐ NR intraocular pressure.* NR with 0.02 mg/ml MMC; ^† NR with 0.1 mg/ml MMC; ^‡ Needle revision.

Figure 2.

Comparisons of cumulative success rate between Group A and Group B (Kaplan‐ Meier survival curve).* Intraocular pressure lesser than 18 mmHg regardless of glaucoma medications; ^† NR with 0.02 mg/ml MMC; ^‡ NR with 0.1 mg/ml MMC.

Table 1.

Patient characteristics

	Group A^* (n=15)	Group B^†(n=15)	P-Value
Age (in yrs : mean±SD)	52.8±14.6	56.3±18.7	0.940^††
Male:Female	12:3	7:8	0.058^‡‡
Diabetes	6 (40%)	7 (46.7%)	1.000^‡‡
Hypertension	4 (26.7%)	3 (20%)	1.000^‡‡
Pre‐ NR^‡ IOP (mmHg)			0.129^‡‡
≥ 25 mmHg	4	5
< 25 mmHg	11	10
Type of glaucoma			1.000^‡‡
Primary^∏	6	8
Secondary^#	9	7
Original filtration surgery			0.389^‡‡
TL^** without MMC	5	2
TL^** with MMC	10	13
TL^**			0.715^‡‡
Without cataract surgery	6	8
With cataract surgery	9	7
No. of times of NR	1.9±2.3	2.4±2.0	0.553^††
Interval after TL^**	1.7±1.4	1.6±1.0	0.802^††

^* NR with 0.1mg/ml MMC

^† NR with 0.02 mg/ml MMC

^‡ Needle revision

^§ Intraocular pressure

^∏ Primary open-angle glaucoma, primary angle-closure glaucoma, and normal tension glaucoma

^# Neovascular glaucoma, inflammation induced glaucoma, complicated glaucoma;

^** Trabeculectomy;

^†† T-test

^‡‡ Chi-square test.

Table 2.

Characteristics of patients with success and failure following needle revision for failed blebs

	Success (n=26)	Failure (n=4)	P-Value
Age (in yrs : mean±SD)	56.4±15.5	57.5±23.6	0.668^#
Male:Female	16:10	3:1	1.000^**
Diabetes	14 (53.8%)	3 (75%)	0.612^**
Hypertension	21 (90.7%)	2 (50%)	0.554^**
Pre‐ NR^* IOP^† (mmHg)			0.129^**
≥ 25 mmHg	12	0
< 25 mmHg	14	4
Type of glaucoma			0.601^**
Primary	13	3
Secondary	13	1
Original filtration surgery			1.000^**
TL^∏ without MMC	6	1
TL with MMC	20	3
TL		2	1.000^**
Without cataract	14	2
With cataract	12
NR			0.099^**
With 0.02 mg/ml MMC	15	0
With 0.1 mg/ml MMC	11	4
No. of times of NR	2.2±2.2	2.0±2.0	0.105^#
Interval after TL	1.6±1.2	1.6±0.7	0.540^#

^* Needle revision

^† Intraocular pressure

^‡ Primary open angle glaucoma, primary angle closure glaucoma, and normal tension glaucoma

^§ Neovascular glaucoma, inflammation induced glaucoma, complicated glaucoma

^∏ Trabeculectomy;

^# Wilcoxon lank sum test

^** Fisher’s exact test.

Table 3.

Post‐ NR complications

Complication	No. of eyes
	Group A^*	Group B^†
Subconjunctival hmr^‡	1	1
Subconjunctival hmr.& Hyphema	0	1
Subconjunctival hmr. & Shallow A/C^§	1	0
Subconjunctival hmr.& Leaking	1	0
Hyphema	0	2
Shallow A/C	2	0
Leaking	1	2
Shallow A/C & Leaking	0	1
Choroidal detachement	0	1
Avascular change of conjunctiva	0	2
Total	6	10

^* NR with 0.02 mg/ml MMC

^† NR with 0.1 mg/ml MMC;

^‡ Subconjunctival hemorrhage

^§ Anterior chamber.

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