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In this video, a patient presenting with an obstructed trabeculectomy bleb has a revision performed using an ab externo bleb needling approach. The procedure begins by inserting a corneal traction suture for improved access to the scarred bleb and is followed by the insertion of an infusion canula providing a continuous source of balanced salt solution. A bent 25- or 27-gauge needle is then used to carefully disrupt the scar tissue within the bleb. The procedure concludes with the injection of mitomycin-c, an anti-fibrotic agent that aims to promote the longevity of the cleared bleb.
Boland has consulted for Carl Zeiss Meditec, Topcon Healthcare, Allergan, and Janssen.
1. Demirok G, Kaderli A, Kaderli ST, Üney G, Yakin M, Ekşioğlu Ü. Factors affecting the early and mid-term success of needling for early failure of filtering bleb. Indian J Ophthalmol. 2021;69(2):296-300. doi:10.4103/ijo.IJO_533_20
2. Greenfield DS, Miller MP, Suner IJ, Palmberg PF. Needle elevation of the scleral flap for failing filtration blebs after trabeculectomy with mitomycin C. Am J Ophthalmol. 1996;122(2):195-204. doi:10.1016/s0002-9394(14)72010-0
3. Feyi‐Waboso A, Ejere HO. Needling for encapsulated trabeculectomy filtering blebs. Cochrane Database Syst Rev. 2012;2012(8):CD003658. doi:10.1002/14651858.CD003658.pub3
4. Pathak-Ray V, Choudhari N. Rescue of failing or failed trabeculectomy blebs with slit-lamp needling and adjunctive mitomycin C in Indian eyes. Indian J Ophthalmol. 2018;66(1):71-76. doi:10.4103/ijo.IJO_523_17
5. Murdoch I. When trabeculectomy fails. Community Eye Health. 2012;25(79-80):76.
6. Chen X, Suo L, Hong Y, Zhang C. Safety and Efficacy of Bleb Needling with Antimetabolite after Trabeculectomy Failure in Glaucoma Patients: A Systemic Review and Meta-Analysis. J Ophthalmol. 2020;2020:e4310258. doi:10.1155/2020/4310258
7. Das N, Manju M, Chandran P, et al. Outcomes of bleb needling in primary glaucoma: A prospective interventional study in a South Indian population. Indian J Ophthalmol. 2022;70(12):4201. doi:10.4103/ijo.IJO_1204_22
8. Shin DH, Kim YY, Ginde SY, et al. Risk factors for failure of 5-fluorouracil needling revision for failed conjunctival filtration blebs. Am J Ophthalmol. 2001;132(6):875-880. doi:10.1016/s0002-9394(01)01232-6
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