Joseph Anthony Tumbocon, MD
Miguel Luis Guillermo
Trabeculectomy bleb needling is a useful procedure to save or resuscitate a failing or hypo-functioning bleb. This instructional video demonstrates some basic techniques and concepts in bleb needling. Two short videos are presented, one done at the slit-lamp and another in the operating room. The key concepts are: to penetrate the conjunctiva as far as possible from the bleb site, minimize aqueous leakage through the conjunctiva after the procedure, and achieve the endpoint of bleb elevation and expansion with resultant IOP reduction. Subconjunctival injection of antifibrotic, such as fluorouracil, is given after the procedure. Post-needling management is similar to eyes that have undergone trabeculectomy.