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Needling revision of trabeculectomies bleb morphology and long-term survival.

Ophthalmology 2008 July
PURPOSE: To assess the long-term success rate and to determine factors that predict survival after 5-fluorouracil-augmented needling revision of poorly functioning trabeculectomy blebs.

DESIGN: Prospective observational cohort study.

PARTICIPANTS: Eighty-one consecutive patients undergoing bleb needling.

METHODS: Survival analysis was performed after a minimum of 2 years' follow-up. Cox proportional hazards regression analysis was used to test the association between survival and study variables, including bleb morphology.

MAIN OUTCOME MEASURES: Intraocular pressure (IOP) reduction by >20% and to 20% and to
RESULTS: The mean follow-up period was 3.4 years. Survival rates were 64.2%, 54.3%, 45.7%, 31.9%, and 13.0% at 6, 12, 24, 36, and 48 months, respectively, with mean survival of 123.8 weeks (95% confidence interval [CI], 96.3-151.3; median, 74.0) using definition 1. Results for definition 2 were not significantly different. Survival time was shorter if multiple needlings were employed (P = 0.04) or if an immediate reduction in IOP to
CONCLUSIONS: Needling with 5-fluorouracil is an effective intervention in the short to medium term, but long-term results show that additional intervention is necessary in the majority of cases. Bleb morphology can be used to predict success in recent, highly vascularized, or microcystic trabeculectomy blebs.

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