Background: Trabeculectomy is still the gold standard surgery for the surgical management of glaucoma. 1 However, owing to fibrosis is associated with a significant risk of failure. 2 One way to mitigate it is by timely identifying and managing the failing bleb. Once the conservative treatment, including digital massage, steroids, suturolysis, aqueous suppressants, and antimetabolites, fails, surgical intervention by bleb needling is the next step to maintain a functioning bleb. 3 It re-establishes the fistula from the anterior chamber to a subconjunctival bleb. Bleb needling aims to create an opening in the wall of an encapsulated bleb or raise a flattened bleb with a small-gauge needle via subconjunctival insertion at the slit lamp or in the operating room. Purpose: This video-based skill transfer depicts detailed steps of bleb needling both in operation theater and in the outpatient department on slit lamp. Synopsis: Basic bleb needling indications and prerequisites are elaborated in the video. Authors share their tips and tricks of performing bleb needling in phakic and pseudo-phakic patients augmented with injection mitomycin C. Different techniques of bleb needling using needle or Grover’s spatula (ab interno) are demonstrated. The authors also describe how they perform slit-lamp bleb needling. Video link: https: //youtu. be/ₙ4Q3ri3EN8
Maheshwari et al. (Tue,) studied this question.