Subconjunctival Mitomycin-C Injection Results after Revision Failed Trabeculectomy Bleb

Abstract

Background and Objectives: Trabeculectomy is indicated when lOP cannot be controlled enough with medical treatment. Poor filtration after surgery is indicated by increasing IOP and a encapsulated bleb. The aim of this study was to assess the outcomes of long-term effectivness of subconjunctival mitomycin-C as an adjunct to needle revision of failing filtering blebs. Materials and Methods: In a noncomparative, randomized clinical trial 22 consecutive patients (22 eyes) who underwent 0.2 mg/ml of mitomycin-C injection adjunct to needling revision of a failed filtering bleb after trabeculectomy. The success of the needling revision was defined if the intraocular pressure was <21 mmHg with or without antiglaucoma medications. Main outcome measures were intraocular pressure, visual acuity, complications and number of glaucoma medications used at the final visit. Results: Mean preoperative intraocular pressure was 29.048.64 mmHg, which was reduced by 8.712.59 mmHg to a mean postoperative intraocular pressure of 20.367.98 mmHg. Mean follow-up was 6.404.27 months,with success rate 68.2%. The most common complication were choroidal detachment in 13.6% of patients and shallow anterior chamber 4.5%. Conclusions: Bleb revision-needling and subconjuctival mitomycin-C injection can reduce IOP significantly without major complication. Subconjuctival injection mitomycin-C may enhance success of the needling procedure in failing filtering blebs.