Two-Year Outcomes of Bleb Needling Following Primary Glaucoma Filtering Surgery in Primary Open Angle Glaucoma

Document Type

Conference Proceeding

Publication Date

6-2025

Publication Title

Investigative Ophthalmology and Visual Science

Abstract

Purpose : To evaluate the two-year success rate of bleb needling in a predominantly African American population and to identify factors contributing to successful outcomes.

Methods : This retrospective study was conducted at the Kresge Eye Institute, reviewing records of primary open-angle glaucoma patients who underwent trabeculectomy, with or without ExPress Shunt, followed by bleb needling between 2008 and 2018. Patients were followed at three-month intervals for a period of two years. Failure was categorized into three stratified groups based on intraocular pressure (IOP), the number of glaucoma medications required, and the presence of complications (Table 1). Kaplan-Meier survival analysis was utilized to estimate bleb needling success rates, while multivariate Cox regression analysis was performed to identify variables associated with failure.

Results : Seventy-four eyes from 71 patients were included in the study, with the majority of eyes (74.3%) from African Americans. The mean patient age was 68.3 ± 11.2 years. The mean pre-needling IOP was 27.4 ± 8.1 mmHg, the mean pre-needling mean deviation in Humphrey field analysis was -20.8 ± 8.6 dB, and the mean pre-needling number of medications was 3.0 ± 1.7. The overall success rate at 12 months and two years was 28.1% and 14.3%, respectively based on the least stringent criteria. However, the complete success rate (completely weaned off of medications) was 12.7% and 5.1% at 12 months and 2 years, respectively. COX regression analysis revealed age, prior laser surgery, interval between glaucoma filtering surgery-bleb needling, hyperlipidemia, hypertension, diabetes mellitus, and the number of medications pre-bleb needling were not significantly associated with success. The most frequent reasons for bleb needling failure included increased number of glaucoma medications (40%), surgical revision (31.7%), and IOP that exceeded threshold (21.7%).

Conclusions : The trends in mean intraocular pressure (Figure 1) and the mean number of glaucoma medications over the two-year follow-up period demonstrate an initial improvement post-needling, followed by stabilization.
The two-year success rate of bleb needling observed in our study is lower compared to previous reports, which may be attributed to the greater severity of glaucoma in our patient population.

Volume

66

Issue

8

First Page

5111

Comments

Association for Research in Vision and Ophthalmology ARVO Annual Meeting, May 4-8, 2025, Salt Lake City, UT

Last Page

5111

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