Needling for encapsulated trabeculectomy filtering blebs

Trabeculectomy is an eye operation aimed at reducing intraocular pressure in people with glaucoma. A bleb usually forms at the site of operation, indicating aqueous drainage from the eyes. Trabeculectomy blebs can become encapsulated leading to poor drainage and high intraocular pressure. Some ophthalmologists needle encapsulated blebs in order to re-establish drainage and lower intraocular pressure. However, needling is invasive and can potentially be associated with higher risks of complications, such as anterior chamber collapse, infections, and cataract. This review included one trial conducted in Brazil which randomised 25 eyes. The trial compared needling using a 27-gauge needle to medical treatment with aqueous suppressants and digital massage. Outcome measures in the trial were mean intraocular pressure and successful intraocular pressure control (defined arbitrarily as IOP less than 20 mm Hg). This review found no conclusive evidence that needling of encapsulated blebs results in better intra-ocular pressure control than antiglaucoma medication.