Effectiveness of Needling Revision with Mitomycin-C for Failing Blebs

Filtering procedures remain the most popular surgical option for controlling intraocular pressure (IOP) in medically refractory glaucoma. Incorporation of adjunctive anti fibrotic treatment has enhanced IOP control and prolonged filtering efficacy [1-3], but for various reasons some blebs are prone to failure many months or years later. Sometimes that failure may take the form of hyperfiltration and hypotony, but more commonly it comes in the form of scarring or encapsulation of the bleb, with or without sclerostomy or scleral flap obstruction. In such cases the surgeon must decide whether to attempt to restore filtration or find other means for lowering IOP. Reversion to medical therapy is typically inadequate in patients who merited filtering surgery in the first instance. Various laser, tube shunt, canalostomy, and trabecular stripping procedures are among the options available today, each with its own merits and drawbacks. However, as long as there is no direct uveal obstruction of the internal sclerostomy or nonpenetrating drainage zone, restoration of the original filter remains a viable option [4-13].