Transconjunctival mitomycin-C in needle revisions of failing filtering blebs.

Purpose: To report the efficacy and safety of transconjunctival mitomycin-C as an adjunct to needle revision of failing filtering blebs.

Design: Retrospective, consecutive, noncomparative interventional case series.

Participants: Forty-one patients (42 eyes) undergoing bleb revisions by a single surgeon at a single institution from May 1997 to January 2001.

Methods: The authors retrospectively reviewed charts of 42 eyes that underwent needle revision of the failing filtering bleb using transconjunctival application of mitomycin-C. Needling of the bleb was performed with a 25-gauge needle. The site of the needle puncture was sutured and followed by application of transconjunctival mitomycin-C (0.5 mg/ml) by means of a sponge left in contact with the conjunctival epithelium for 6 minutes. A group of patients received additional subconjunctival injections of 5-fluorouracil in the postoperative period. Success was defined as a reduction in intraocular pressure of 30% without the use of antiglaucoma medications and no further surgical procedures to control intraocular pressure.

Main Outcome Measures: Intraocular pressure, visual acuity, complications, number of glaucoma medications used at the final visit.

Results: Mean preoperative intraocular pressure was 22.1 +/- 8.0 mmHg, which was reduced by 9.6 +/- 7.9 mmHg to a mean postoperative intraocular pressure of 12.5 +/- 6.1 mmHg. Mean follow-up was 17.6 +/- 13.5 months. Kaplan-Meier survival analysis showed a probability of continued success at 12 months of 76.1%, and at 24 months of 71.6%. The most common complication was hyphema in 7.1% of patients. Twenty-six eyes also received postoperative injections of 5-fluorouracil.

Conclusions: Transconjunctival mitomycin-C may enhance success of the needling procedure in failing filtering blebs.