The efficacy of transconjunctival needling revision with 5- fluorouracil in encapsulated blebs with elevated intraocular pressure after trabeculectomy

OBJECTIVE: To compare de efficacy of transconjuctival needling revision (TNR) with 5-fluorouracil (5-FU) and medical treatment (MT) in glaucomatous eyes with encapsulated bleb and uncontrolled intraocular pressure (IOP) after trabeculectomy with mitomycin C (MMC) at 12 months follow-up. DESIGN: Prospective, randomized, interventional study. PARTICIPANTS: Forty eyes of 39 patients with encapsulated bleb developed in 5 months or less following primary trabeculectomy with mitomycin and IOP ≥ 20mmHg. METHODS: Eyes were randomized to either TNR with 5-FU or MT. A maximum of two TNR was allowed in the study. All eyes were followed-up for 12 months. Success of treatment was defined as IOP ≤ 18mmHg and a 20% reduction from baseline (no medications in TNR group). RESULTS: Mean IOP at 12 months follow-up was 12.14 ± 2.80 mmHg in the TNR group and 15.13 ± 2.07 mmHg in the MT group (p=0.004). Fourteen eyes (70%) were considered a success in the TNR group and 15 eyes (75%) in the MT group (p=0.89). The number of needling procedure was 1.35 ± 0.49 procedures and the number of medication was 2.15 ± 0.74 medications. CONCLUSIONS: We have demonstrated a similar success rates in eyes randomized to MT in comparison to TNR with 5-FU at the last follow-up. However, a significant lower mean IOP after TNR was observed.