THE TREATMENT OF ENCAPSULATED TRABECULECTOMY BLEBS IN AN OUTPATIENT SETTING USING A NEEDLING TECHNIQUE AND SUBCONJUNCTIVAL 5-FLUOROURACIL INJECTION

Purpose Encapsulation of the trabeculectomy bleb is a common cause of drainage failure in the early post-operative period. The primary manag ement of bleb encapsulation has previously been to restart medical the rapy, but recent advances in the technique of needle manipulation and the introduction of adjunctive 5-fluorouracil (5-FU) have increased th e popularity of early surgical bleb management. By reporting the resul ts of bleb needling in a series of patients, we aim to illustrate its safety and efficacy. Methods We have reviewed a series of 32 eyes in w hich needling and 5-FU injection was performed for bleb encapsulation, and analysed the results over a follow-up period of 10.71+/-2.9 month s. Results In 14 (43.7%) cases, primary needling was performed; in the other 18, needling was performed after conservative treatment had pro ved inadequate. The mean intraocular pressure (IOP) of the group decre ased from 29.2+/-10.5 mmHg prior to needling to 15.9+/-4.0 mmHg at the most recent attendance (paired t-test p = 1.3 x 10(-7)), with all eye s having a final IOP measurement of 22 mmHg or less. Twenty-three (71. 9%) of the cases maintained a target IOP of 18 mmHg or less without ad ditional treatment; 5 (15.6%) were qualified successes with an untreat ed IOP between 19 and 21 mmHg. The remaining 4 (12.5%) patients, whose IOPs ranged between 20 and 22 mmHg with one hypotensive agent, were c onsidered needling failures. Choroidal detachment complicated the proc edure in 2 cases; in each this resolved with conservative management a nd without long-term visual consequence. Conclusion This technique is recommended as a safe and effective method of treating bleb encapsulat ion.