Bleb Needling

What is bleb needling?
During your glaucoma surgery (Trabeculectomy) a small opening is made under the upper eyelid, to let the fluid escape and lower the pressure.

The fluid that flows out of your eye forms a small cyst, called a bleb, which is under the conjunctiva, the thin transparent layer that covers the white of your eye.

Drainage surgery for glaucoma (Trabeculectomy) may fail to bring the pressure low enough or may scar and fail. This can occur shortly after the operation is performed or at any time. In some cases bleb needling may be the next step to restore drainage and achieve a lower eye pressure.

What does the procedure involve?
The needling is usually done in the operating theatre. You will be asked to attend the ward in advance of the treatment time. Further advice about this will be given in the letter discussing your admission details. I will take your written (informed) consent and explain further if you have any questions.

The procedure is usually done under local anaesthetic however some patients may require a general anaesthetic. This will be discussed with you prior to your admission.

The local anaesthetic involves putting in drops that numb the front surface of your eye followed by an injection in the skin around the eye, which will make the area around your eye go numb. This may last for a few hours and can affect your vision at the time.

The needling involves breaking down the wall of the scar tissue using a fine needle. This will help to improve the drainage of the watery fluid called aqueous humour. A jelly like material and an anti-scarring drug is then injected to try to prevent further scar formation.

At the end of the procedure, an injection of antibiotic and steroid is given to reduce the risk of infection and inflammation. Afterwards an eye pad or clear shield will be placed over your eye.

Are there any risks or side effects of this treatment?

• The most sight threatening problems that can occur are bleeding inside the eye, or a serious infection. Antibiotic injection at the surgery and then drops are given to help to prevent infection. These complications are rare and occur in less than 1 in 1000 operations.
• The pressure in the eye may rarely go too low after the operation and require further intervention.
• The anti-scarring agent may cause the wound to leak or may change the surface of the cornea (the clear window at the front of your eye). This recovers in almost all cases.

After the needling you may experience some slight discomfort.You may wish to take a mild painkiller, for example Paracetamol, to relieve this discomfort. If you are already taking painkillers for a different condition continue with these, but do not take both.