Purpose:

To evaluate the results of bleb needling of encapsulated blebs with 1% mitomycine-C (Mtm-C) after trabeculectomy surgery.

Material and Method:

98 eyes of 90 glaucoma patients who had undergone trabeculectomy between July 2009 and September 2011 were evaluated retrospectively. Twenty-five eyes of 24 patients who developed encapsulated bleb with at least 3-month follow-up were enrolled in the study. These patients had undergone bleb needling with 1% Mtm-C (16 eyes) since medications were not efficient for IOP control. The pre- and post-needling intraocular pressures (IOP) were compared with IOPs being controlled with anti-glaucoma medications (9 eyes).

Results:

Encapsulated bleb was seen in 25 (25.6%) eyes of 24 patients out of 98 eyes of 90 patients who had trabeculectomy. The mean age was 62.6±13.6 (23-83) years and the mean follow-up time was 5.7±4.4 (3-20) months. The mean time that encapsulated blebs were diagnosed was 4.1±1.5 (2.5-8) weeks after the trabeculectomy. The number of eyes with IOP controlled with medication only was 9 (36%) with 5.7±4.0 (3-14) months mean follow-up time. Mtm-C 1% bleb needling was performed at mean 9.1±3.2 (3-15) weeks after trabeculectomy in 16 eyes (64%) which had uncontrolled IOP with medical treatment. The IOPs before surgery and at postoperative 1st week, 1st, 3rd, and 6th months were 26.5±8.6 mmHg, 11.9±2.6 (5-18) mmHg, 14.5±3.8 (11-20) mmHg, 15.2±5.6 (8-20) mmHg, and 14.8±1.4 (8-28) mmHg, respectively (p<0,01). The numbers of anti-glaucoma medication before surgery and at postoperative 1st week, 1st, 3rd, and 6th months of needling were 2.1±0.7, 0.3±1.2, 1.1±1.4, 0.7±1.2, and 1.3± 0.8, respectively (p<0.05).

Discussion:

One of the complications which compromises the IOP reduction after filtrating glaucoma surgery is formation of encapsulated bleb. Needling of encapsulated bleb with 1% Mtm-C is a safe and efficient surgical treatment in patients who have inadequate IOP reduction with anti-glaucoma medications.

Keywords: Encapsulated bleb, filtering surgery, bleb needling