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Case Presentation: A 43-year-old man with primary open-angle glaucoma of the right eye had undergone Ahmed valve implantation two years earlier and bilateral trabeculectomy with mitomycin C one year earlier elsewhere; needling with 5-FU one month before presentation had failed. On four topical agents and oral acetazolamide, intraocular pressure (IOP) was 18 mmHg versus 8 mmHg in the fellow eye, with progressive field loss (mean deviation −18.10 dB) and best-corrected visual acuity (BCVA) 0.9. The bleb was flat and adherent. Bleb revision used 0.1 mL of 5-FU (40 mg/mL) injected subconjunctivally at least 7 mm from the needling site, followed by 30 minutes supine before needling with a 25-gauge MVR blade. A conjunctival leak was sutured and later removed.
Results: At one week, IOP was 6 mmHg with BCVA 0.2; anterior segment optical coherence tomography (OCT) showed a shallow anterior chamber with choroidal effusion, and macular OCT showed chorioretinal folds with oedema. Corticosteroid was stopped, homatropine 2% given three times daily, and a protective shield worn overnight. One week later IOP was 8 mmHg with recovered chamber depth, resolved effusion and regressing folds. At two months, IOP was 8 mmHg, BCVA 0.8, folds almost absent, and all topical and oral IOP-lowering treatment had been withdrawn.
Conclusion: 5-FU–augmented needling restored filtration and eliminated five IOP-lowering agents, but abrupt outflow restoration precipitated hypotony with choroidal effusion and maculopathy. Cycloplegia with corticosteroid withdrawal reversed all findings without surgical intervention. Early anterior segment and macular imaging is advisable after needling, particularly when a drainage implant is already present.
Keywords: trabeculectomy; Bleb Needling; 5-Fluorouracil; Ocular Hypotony; Hypotony Maculopathy; Choroidal Effusion
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