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Purpose: To assess the efficacy of needle revision using mitomycin C (MMC) for reviving failed filtering blebs during the late postoperative period and its safety for the corneal endothelium., Design: Prospective interventional case series., Participants: We recruited 125 eyes from 98 patients with uncontrolled glaucoma. All had at least 1 failed trabeculectomy, a flat filtering bleb, and a patent internal ostium on gonioscopy. The average time between the last trabeculectomy and needle revision was 5.3±5.3 years (range, 6 months to 30 years)., Intervention: Needling revision with a subconjunctival injection of 8 μg of MMC., Main Outcome Measures: Intraocular pressure (IOP) and number of hypotensive medications at latest visit, central corneal thickness (CCT), corneal endothelial cell density (ECD), coefficient of variation of cell size (CV), and hexagonality before and after needling., Results: We performed 186 needling procedures on 125 eyes (mean, 1.5±0.6 procedures/eye). Seventy-three eyes (58.4%) were needled once, 44 eyes (35.2%) were needled twice, 7 eyes (5.6%) were needled 3 times, and 1 eye (0.8%) was needled 4 times. We reestablished aqueous flow and obtained a raised bleb in 115 eyes (92%). After an average follow-up of 20.8±12.0 months, the mean IOP decreased from 20.1±5.2 mmHg preoperatively to 13.2±6.8 mmHg (P<0.001), and the mean number of hypotensive medications per eye decreased from 2.4±1.1 to 0.8±1.3 (P<0.001) at the latest visit. The overall success rate (IOP ≤16 mmHg) was 76% (58.4% without medication and 17.6% with hypotensive medications). Kaplan-Meier survival rates were 91.2% at the 1-month follow-up, 84.5% at 6 months, 81.0% at 1 year, 74.6% at 2 years, and 66.3% at 3 years. We studied the corneal endothelium in 42 eyes of 36 patients. There was no statistically significant difference between preoperative CCT, ECD, CV, or hexagonality and postoperative measurements at 1 week and 1, 3, 6, and 12 months., Conclusions: Needling revision with adjunctive MMC is effective for reviving flat filtering blebs and controlling IOP, even several years after the original trabeculectomy, and seems to be safe for the corneal endothelium., (Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To report quantitative changes in the anterior segment configuration after clear corneal incision phacoemulsification and foldable intraocular lens (IOL) implantation by means of ultrasound biomicroscopy (UBM)., Design: Prospective, nonrandomized, comparative (self-controlled) trial., Participants: Twenty-one eyes of 19 patients with senile or presenile cataracts and no other ocular illness., Methods: Patients were examined with UBM before and 1 and 3 months after surgery. At each UBM examination, axial images of the anterior chamber and radial sections of the angle at the superior, lateral, inferior, and medial quadrants were obtained., Main Outcome Measures: Central anterior chamber depth (ACD), iris-lens contact distance, iris-lens angle (ILA), angle opening distance at points 250 (AOD250) and 500 microm (AOD500) from the scleral spur, trabecular-iris angle (TIA), iris thickness 500 microm from the scleral spur (IT), trabecular-ciliary process distance (TCPD), iris-ciliary process distance (ICPD), iris-zonule distance, iris-sclera angle (ISA), and ciliary process-sclera angle (CPSA). After surgery, central anterior chamber depth was also measured from the cornea to the IOL (ACD) and from the cornea to the pupillary plane (ACD2). Each variable was measured twice in different days by the same observer., Results: The variables IT, TCPD, ICPD, IZD, and CPSA did not significantly change after surgery (P > 0.01). Central anterior chamber depth increased approximately 30% after surgery (approximately 850 microm; P < 0.001), by both measurement methods used (ACD x ACD and ACD x ACD2). Anterior chamber angle significantly increased, by approximately 50% of the initial value, by the three measurement methods used: AOD250 (P