The Effectiveness of single procedure of Slit-lamp Needling Revision with low dose Mitomycin-C (0.1 mg/ml) as an alternative to surgical revision for bleb Failure at Preah Ang Duong Hospital in Cambodia
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Abstract
Background: Bleb needling revision with Mitomycin-C has been known as a common procedure performed after failed trabeculectomy around the world. Numerous studies show a high success rate of slit-lamp needling revision with high dose Mitomycin-C. To our best knowledge, there are currently no known studies showing the efficacy of single needling procedures with low dose Mitomycin-C for bleb revision. The authors conducted a study to investigate the efficacy and safety of this procedure.
Objectives: This study aims to investigate the efficacy and safety of a single procedure of slit-lamp needling revision with low dose Mitomycin C (0.1 mg/ml) in bleb failure in Cambodian eyes.
Methods: It’s a prospective and non-comparative study involving 32 eyes of 32 uncontrolled glaucoma patients after trabeculectomy. All procedures were performed at Preah Ang Duong Hospital from March 2021 to March 2022. Bleb needling was performed on slit-lamp using a 26-gauge needle to open the flap, and 0.1 ml of 0.1 mg/ml MMC was injected 2 millimeters posteriorly to the superior scleral flap side to the sub-tenon space. The outcome measurements are described as rate of success , intraocular pressure, number of antiglaucoma medications, bleb morphology changes and complications at three time points (one month, three months, and six months).
Results: In our study, we found 3.12 % of complete success and 96.88% of qualified success at the end-point. A significant reduction of IOP (from 24.12 +/- 4.52 mmHg to 11.93 +/- 1.24 mmHg, p < 0.001) and number of anti-glaucoma medications (2.96 +/- 0.64 to 1.53 +/- 0.62) was also demonstrated. There’s no statistically significant change in bleb morphology, however diffused blebs were found. No serious complications were found during the study.
Conclusion: Slit-lamp needling revision with low dose Mitomycin-C appears to be efficacious and safe for restoring bleb function in glaucomatous eyes with bleb failures.
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