Long-term outcome of mitomycin C-augmented needle revision of trabeculectomy blebs for late trabeculectomy failure

Objectives To describe the 3-year outcomes of mitomycin C (MMC)-augmented bleb needling procedures following late trabeculectomy failure. Methods A retrospective, observational chart review of 44 eyes that underwent MMC-augmented bleb needling following late trabeculectomy failure. The primary outcome measure was IOP at 3 years post-operatively. Secondary outcome measures were the number of topical glaucoma medications and success rate at 3 years. Success was defined on the basis of IOP (<= 21 mmHg and >= 5 mmHg with a reduction of >= 20% from pre-operative baseline), need for ocular hypotensive medications, and need for further laser or surgical intervention. Results Mean TOP was reduced from 19.8 mmHg preoperatively to 13.9 mmHg (29.5% reduction) at 3 years. By the 3-year time point, 26 eyes (59.1%) had met one or more of the criteria for failure. A lower immediate post-operative TOP was found to be associated with greater likelihood of success. Conclusions Bleb needling augmented with MMC can achieve a significant reduction in TOP in eyes with late trabeculectomy failure. By 3 years however, 59% of eyes were classified as failures, with half requiring further glaucoma surgery or laser. Patients undergoing this procedure should therefore be warned of the likelihood of requiring further intervention, and a repeat antimetabolite-augmented trabeculectomy or glaucoma tube shunt surgery in the first instance can be considered instead.