What is the role of bleb needling following trabeculectomy?

Updated: May 18, 2020
  • Author: Maria Hannah Pia Uyloan de Guzman, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Answer

Bleb needling

Bleb needling can be performed in the immediate postoperative period or months to years after the trabeculectomy. [24, 25, 26, 27] When subconjunctival and subflap adhesions have developed or are suspected to have developed, the usual measures to increase aqueous flow and reduce inflammation may no longer be effective. When this occurs, bleb needling may be needed to break the adhesions.

There are many techniques of bleb needling. One technique is to use a G25 or G27 needle on a tuberculin syringe loaded with the antifibrotic agent of choice (usually 5-FU). This is inserted into the conjunctiva at least 7-8 mm away from the scleral flap edge, avoiding blood vessels as much as possible. The needle is then brought toward the flap, sweeping the bevel from side to side as it approaches. The bleb may begin elevating already at this point. If necessary, the needle can even be inserted under the flap if the flap edges are visible. Before fully withdrawing the needle, the antifibrotic is injected into the peribleb area the same way it is done for a simple antifibrotic injection. The potential serious complications of this procedure include choroidal effusion, suprachoroidal hemorrhage, blebitis, hypotony, and bleb leak.


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