Slit-Lamp Bleb Needling with Mitomycin C for Failed or Failing Trabeculectomy: A Retrospective Study

Purpose: To evaluate the safety and efficacy of slit-lamp bleb needling with adjunctive mitomycin C (MMC) for raised intraocular pressure (IOP) following trabeculectomy or combined phacotrabeculectomy. Methods: This retrospective chart review included 262 patients who underwent trabeculectomy or phacotrabeculectomy. Thirty eyes with postoperative IOP above 21 mmHg after the first postoperative month underwent slit-lamp bleb needling with 0.1 mL of 0.04% MMC.A repeat procedure was performed when IOP remained above 21 mmHg. Outcomes and complications were assessed during follow-up of 6 months to 4 years. Results: Of the 30 eyes treated, 22 (73.3%) achieved IOP below 21 mmHg without medication at one year. Six eyes (20.0%) required one or more medications, while two (6.7%) required repeat trabeculectomy with MMC. Transient hyphema occurred in seven eyes and choroidal effusion in three; both complications resolved with medical management. No bleb-related endophthalmitis or loss of vision was reported. Conclusion: Slit-lamp bleb needling with low-dose MMC was associated with useful pressure control and few reported complications in this selected series. It may offer an outpatient option for managing a failing filtration bleb, although prospective comparative studies are needed in routine ophthalmic clinical practice settings.