Needle revision outcomes after glaucoma filtering surgery: survival analysis and predictive factors

• Published in: European journal of ophthalmology Vol. 30; no. 2; pp. 350 - 359
• Main Authors: Rabiolo, Alessandro, Marchese, Alessandro, Bettin, Paolo, Monteduro, Davide, Galasso, Mario, Dolci, Maria Paola, Di Matteo, Federico, Fiori, Marina, Ciampi, Carlo, Bandello, Francesco
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-03-2020
• Subjects: Adult; Aged; Aged, 80 and over; Antimetabolites - administration & dosage; Combined Modality Therapy; Female; Fluorouracil - therapeutic use; Glaucoma - surgery; Humans; Intraocular Pressure; Male; Middle Aged; Needles; Ocular Hypotension - surgery; Postoperative Complications - surgery; Reoperation - methods; Retrospective Studies; Sclera - surgery; Survival Analysis; Trabeculectomy - methods; 5-fluorouracil; filtering bleb; trabeculectomy; Antimetabolites; betamethasone; needling
• ISSN: 1120-6721; 1724-6016
• DOI: 10.1177/1120672119830861

Purpose:
To evaluate the efficacy and safety of needle revision and examine factors predictive of failure.
Methods:
In total, 157 eyes of 131 patients that underwent needle revision augmented with either 5-fluorouracil or betamethasone for trabeculectomy failure were included in this retrospective study. Complete failure was defined as additional glaucoma surgery, ciliodestructive procedures, loss of light perception, sight-threatening complications, hypotony maculopathy, and surgical bleb revision. Success was defined as intraocular pressure ⩽ 18 (criterion A), ⩽15 (criterion B), and ⩽12 mmHg (criterion C) reached with (qualified) or without (complete) medications, and absence of any criteria of complete failure.
Results:
The median (interquartile range) follow-up was 25.0 (41.0) months. Complete failure rates were 19%, 26%, and 31% at 1, 2, and 3 years, respectively. For criterion A, qualified and complete success rates were, respectively, 77% and 69% at 1 year, 66% and 51% at 2 years, and 60% and 47% at 3 years. For criterion B, qualified and complete success rates were, respectively, 67% and 61% at 1 year, 48% and 42% at 2 years, and 44% and 39% at 3 years. For criterion C, qualified and complete success rates were, respectively, 43% and 41% at 1 year, 27% and 25% at 2 years, and 24% and 23% at 3 years. High baseline intraocular pressure and primary surgery were associated with higher and lower risks of complete failure, respectively.
Conclusion:
Needle revision is an effective and safe procedure to rescue failing trabeculectomy postponing or avoiding further glaucoma surgery. Eyes with low target intraocular pressure may have poor long-term outcomes.