Outcomes of bleb needling with 5-fluorouracil post trabeculectomy among glaucoma patients in Kelantan.

Abstract

Purpose: To evaluate the outcomes of bleb needling with 5-FU post-trabeculectomy among glaucoma patients in Kelantan.

Methods: A retrospective analysis of glaucoma patients undergoing bleb needling with 5-FU from January 2020 to December 2023 was conducted at Hospital Raja Perempuan Zainab II with at least one year of follow-up post-needling. Outcomes were assessed based on intraocular pressure (IOP), use of anti-glaucoma medication (AGM), complications, and overall success rates. Statistical comparisons were made using Fisher’s exact test and Mantel-Haenszel chi-square.

Results: Twenty-four patients completed the one-year follow-up, all of whom were predominantly Malay (100%) with a median age of 54 years. Primary open-angle glaucoma accounted for 45.8% of cases. The median IOP was significantly reduced from 22 mmHg pre-needling to 12 mmHg at 12 months post-needling. AGM use decreased substantially, with nearly two-thirds requiring no AGM after one year. Complete and qualified success rates were 62.5% and 20.8%, respectively. Subconjunctival haemorrhage (87.5%) was the most common complication, while hypotony occurred more frequently in failed cases. Success was significantly associated with a reduction in AGM use (p = 0.018).

Conclusion: Bleb needling with 5-FU demonstrates high efficacy and acceptable safety in managing failing trabeculectomy blebs among glaucoma patients in Kelantan. Sustained IOP reduction and reduced AGM use highlight its potential in resource-constrained settings. Prior AGM usage and patient age might influence surgical success. Vigilance regarding complications like hypotony is essential for optimizing outcomes. Larger, prospective studies are recommended to validate predictive factors of success.