Abstract
The postoperative management in trabeculectomy plays a very important role in achieving long-term intraocular pressure lowering and corresponding decrease in risk of progressive glaucomatous optic neuropathy. We describe here a new approach we have been using for several years, ab-interno trans-corneal needling of the scleral wound and bleb, performed at the slit lamp. The procedure offers logistical, financial, and psychological advantages over standard trans-conjunctival bleb needling techniques. Preliminary, unpublished results suggest relatively high efficacy and safety compared to trans-conjunctival techniques.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Chen C-W. Enhanced intraocular pressure controlling effectiveness of trabeculectomy by local application of mitomycin-C. Trans Asia-Pacific Acad Ophthalmol. 1983;9:172–7.
Chen C-W, Huang HT, Bair JS, Lee CC. Trabeculectomy with simultaneous topical application of mitomycin-C in refractory glaucoma. J Ocul Pharmacol. 1990;3:175–82.
Heuer DK, Gressel MG, Parrish II RK, et al. 5-Fluorouracil and glaucoma filtering surgery. II. A pilot study. Ophthalmology. 1984;91(4):384–94.
The Fluorouracil Filtering Surgery Study Group. Five-year follow up of the fluorouracil filtering surgery study. Am J Ophthalmol. 1996;121:349–66.
Greenfield DS, Miller MP, Suner IJ, Palmberg PF. Needle elevation of the scleral flap for failing filtration blebs after trabeculectomy with mitomycin C. Am J Ophthalmol. 1996;122(2):195–204.
Wells AP, Cordeiro MF, Bunce C, Khaw PT. Cystic bleb formation and related complications in limbus- versus fornix-based conjunctival flaps in pediatric and young adult trabeculectomy with mitomycin C. Ophthalmology. 2003;110:2192–7.
Hoskins Jr HD, Migliazzo C. Management of failing filtering blebs with the argon laser. Ophthalmic Surg. 1984;15(9):731–3.
Traverso CE, et al. Focal pressure: a new method to encourage filtration after trabeculectomy. Ophthalmic Surg. 1984;15:62.
Ewing RH, Stamper RL. Needle revision with and without 5-fluorouracil for the treatment of failed filtering blebs. Am J Ophthalmol. 1990;110:254–9.
Mardelli PG, Lederer Jr CM, Murray PL, et al. Slit-lamp needle revision of failed filtering blebs using mitomycin C. Ophthalmology. 1996;103:1946–55.
Latina MA, Rankin GA. Internal and transconjunctival neodymium: YAG laser revision of late failing filters. Ophthalmology. 1991;98:215–21.
Rankin GA, Latina MA. Transconjunctival Nd-YAG laser revision of failing trabeculectomy. Ophthalmic Surg. 1990;21:365–7.
Weber PA, Jones JH, Kapetansky F. Neodymium: YAG transconjunctival laser revision of late-failing filtering blebs. Ophthalmology. 1999;106:2023–36.
Kasahara N, Sibayan SA, Montenegro MH, Simmons RB, Smith TJ. Corneal incision phacoemulsification and internal bleb revision. Ophthalmic Surg Lasers. 1996;27:361–6.
Pasternack JJ, Wand M, Shields MB, Abraham D. Needle revision of failed filtering blebs using 5-fluorouracil and a combined ab-externo and ab-interno approach. J Glaucoma. 2005;14:47–51.
Palmberg P. The failing filtering bleb. In: Liebmann JM, editor. Glaucoma diagnosis and management. Ophthalmol Clin N Am 2000;13(3): 517–29.
Palmberg P. Prevention and management of complicated hypotony in trabeculectomy with mitomycin. Highlights Ophthalmol. 1993;21(9):1. -67-77.
Suner IJ, Greenfield DS, Miller MP, et al. Hypotony maculopathy after filtering surgery with mitomycin C. Incidence and treatment. Ophthalmology. 1997;104:207–14.
Compliance with Ethical Requirements
Dr. Palmberg declares no Conflict of Interest. This presentation is based upon a limited case series, does not constitute human subjects research and is exempt from Institutional Review Board review. No animal studies were performed by the author for this article.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
13.1 Electronic Supplementary Material
Video 13.1
Ab-Interno Trabeculectomy Revision; Paul F. Palmberg, MD, PhD (MP4 4,989 kb)
Rights and permissions
Copyright information
© 2015 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Palmberg, P.F. (2015). Ab-interno Bleb Needling. In: Aref, A., Varma, R. (eds) Advanced Glaucoma Surgery. Essentials in Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-319-18060-1_13
Download citation
DOI: https://doi.org/10.1007/978-3-319-18060-1_13
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-18059-5
Online ISBN: 978-3-319-18060-1
eBook Packages: MedicineMedicine (R0)