Mitomycin-C needle bleb revision in congenital glaucoma

Purpose and Settings: This study was designed to evaluate the efficacy and safety of mitomycin-C (MMC) augmented needling procedure in the management of failed bleb after trabeculectomy in congenital glaucoma. This study was carried out at Ain Shams University Hospital. Patients and Methods: A retrospective study was carried on 30 eyes of 25 patients with congenital glaucoma with bleb failure after trabeculectomy. The mean age of the subjects was 7.3 ± 3.4 years (range, 1-12 years). Under general anesthesia, needling procedure was performed with adjunctive use of a mixture of 0.1 mL of MMC (0.04 mg/mL) and 0.2 mL of lidocaine 1% injected subconjunctivally. Needling was performed with a 30-gauge needle to dissect the areas of subconjunctival fibrosis and re-establish aqueous outflow. Results: Follow-up ranged from 6 to 20 months (mean, 9.23 ± 5.25 months). One needling revision was performed in 22 eyes (73.3%) and eight eyes (26.7%) received two needle revisions. The mean intraocular pressure (IOP) decreased from 26.9 ± 2.85 mmHg (range, 21-34 mmHg) before surgery to 15.63 ± 3.15 mmHg (range, 10-24 mmHg) at last follow-up. Complications included significant subconjunctival hemorrhage in six eyes, intraoperative bleb leak in two eyes, choroidal detachment in one eye, and minimal hyphema in one eye. Conclusion: MMC needle bleb revision appears to be an effective method to revive failed filtration surgery after trabeculectomy in patients with congenital glaucoma. This technique is effective in reducing IOP with preservation of the remaining conjunctiva for further surgery.