NEEDLING VERSUS MEDICAL-TREATMENT IN ENCAPSULATED BLEBS - A RANDOMIZED, PROSPECTIVE-STUDY

Objective: The purpose of the study is to compare the efficacy and saf ety of transconjunctival needling and medical treatment in eyes with e ncapsulated blebs, Design: A randomized, prospective study. Participan ts: Two hundred eighty-two eyes that underwent a guarded filtration pr ocedure between January 1994 and January 1996 at the Glaucoma Service of University of Campinas. Intervention: Encapsulated blebs developed in 25 (8.9%) of 282 eyes and were randomized to either needling (n = 1 4) or medical treatment with aqueous humor suppressants (n = 11). If o ne treatment failed to maintain intraocular pressures (IOPs) below 20 mmHg, the other treatment was initiated. If both methods failed, surgi cal revision or further glaucoma surgery was performed. Complete succe ss was defined as IOP less than 20 mmHg after one treatment method. Qu alified success was defined when IOPs less than 20 mmHg were obtained with both treatment methods, whereas failure was defined when IOP grea ter than 20 mmHg or when further surgery was indicated. Main Outcome M easures: Intraocular pressure, vision, and number of antiglaucoma medi cations. Results: After a mean follow-up of 9.6 months, medical treatm ent alone was successful in ten patients (90.9%), whereas needling alo ne was successful in one patient (7.1%) (P = 0.00003). In the needling group, 92.9% of the eyes required aqueous humor suppressants, and 57. 1% were considered qualified successes at the last follow-up (mean = 1 0.1 months). At the last follow-up examination, there was no statistic ally significant difference between the mean number of medications in both groups (P = 0.797), Further glaucoma surgery was performed in fiv e patients (35.7%) undergoing needling and one patient (9.1%) receivin g medical treatment (P = 0.162). Conclusions: Medical treatment with d igital pressure should be used as the initial treatment in eyes with e ncapsulated blebs. Needling procedures or surgical revision, methods t hat are more invasive and potentially associated with severe complicat ions, should be limited to the small percentage of eyes that do not re spond to medical treatment.