[Buckling Surgery: Old Fashioned or Cutting Edge?] / Buckelchirurgie: Old Fashion oder Cutting Edge?

For many decades, scleral buckling surgery was the only reasonable surgical procedure in eyes with primary rhegmatogenous retinal detachment. In recent years, primary vitrectomy has apparently become the treatment of choice, although evidence from comparative clinical trials is missing. In this article, data from clinical trials and indications for buckling surgery are presented.

[ChatGPT and the German board examination for ophthalmology: an evaluation]. / ChatGPT und die deutsche Facharztprüfung für Augenheilkunde: eine Evaluierung.

PURPOSE: In recent years artificial intelligence (AI), as a new segment of computer science, has also become increasingly more important in medicine. The aim of this project was to investigate whether the current version of ChatGPT (ChatGPT 4.0) is able to answer open questions that could be asked in the context of a German board examination in ophthalmology. METHODS: After excluding image-based questions, 10 questions from 15 different chapters/topics were selected from the textbook 1000 questions in ophthalmology (1000 Fragen Augenheilkunde 2nd edition, 2014). ChatGPT was instructed by means of a so-called prompt to assume the role of a board certified ophthalmologist and to concentrate on the essentials when answering. A human expert with considerable expertise in the respective topic, evaluated the answers regarding their correctness, relevance and internal coherence. Additionally, the overall performance was rated by school grades and assessed whether the answers would have been sufficient to pass the ophthalmology board examination. RESULTS: The ChatGPT would have passed the board examination in 12 out of 15 topics. The overall performance, however, was limited with only 53.3% completely correct answers. While the correctness of the results in the different topics was highly variable (uveitis and lens/cataract 100%; optics and refraction 20%), the answers always had a high thematic fit (70%) and internal coherence (71%). CONCLUSION: The fact that ChatGPT 4.0 would have passed the specialist examination in 12 out of 15 topics is remarkable considering the fact that this AI was not specifically trained for medical questions; however, there is a considerable performance variability between the topics, with some serious shortcomings that currently rule out its safe use in clinical practice.

[Removal of centrally located subretinal perfluorocarbon liquid]. / Entfernung von zentral gelegenem, subretinalem Perfluorcarbon.

BACKGROUND: Subretinal perfluorocarbon liquid (PFCL) droplets are occassionally seen after vitreoretinal surgery for retinal detachment. Usually they are located peripherally without causing complications and therapeutic consequences. In contrast, centrally located PFCL droplets affect final visual outcomes. In animal experiments subretinal PFCL has caused direct toxic effects on photoreceptor cells and retinal pigment epithelium. PATIENTS AND METHODS: We report about the rare event of a centrally located subretinal PFCL droplet in 2 patients, their surgical removal and functional outcome. In both patients a PFCL droplet remained subretinally after primary vitrectomy for a rhegmatogenous retinal detachment. In patient 1 the PFCL droplet was located subfoveally for 6 weeks, in patient 2 underneath the papillomacular bundle for 8 weeks causing severe visual loss. In both patients the PFCL was removed transretinally through a 32 gauge cannula. Vision and central scotoma improved in both patients markedly. No complications due to the mini-retinotomy could be observed. CONCLUSION: Centrally located PFCL droplets are decreasing vision and should be surgically removed. A transretinal removal of subretinal PFCL droplets is possible and the iatrogenic damage seems acceptable.

[Intraocular inflammation with brolucizumab use : Patient management-diagnosis-therapy]. / Intraokulare Entzündungen bei Brolucizumab-Anwendung : Patientenmanagement ­ Diagnose ­ Therapie.

The anti-vascular endothelial growth factor (anti-VEGF) agent brolucizumab has been approved in the USA in October 2019 and in Europe in February 2020 for the treatment of neovascular age-related macular degeneration (nAMD). The approval was based on the randomized, double-blind phase III studies HAWK and HARRIER with a total of 1817 patients. Brolucizumab 6 mg (administered every 12 or 8 weeks depending on the activity of the disease) showed a non-inferior efficacy in terms of best-corrected visual acuity compared to aflibercept 2 mg (administered every 8 weeks). Initial reports on the use of brolucizumab after its approval in the USA indicated a safety signal of rare adverse events termed as retinal vasculitis and/or retinal vascular occlusion that may result in severe loss of vision. Typically, these events occurred in the presence of intraocular inflammation (IOI). A safety review committee (SRC) subsequently carried out an independent analysis of data from the pivotal studies. This article sets out the current state of knowledge and aims to provide users with orientation-from the authors' perspective-in treating brolucizumab-associated IOI. It appears mandatory to provide patients with information about possible symptoms of IOI. Even though the case reports and the SRC review of HAWK/HARRIER may not yet provide sufficient evidence for any final conclusions, it seems crucial to educate patients about signs and symptoms to ensure an early detection and diagnosis in cases of IOI. Once a patient is diagnosed with IOI, retinal vasculitis, and/or retinal vascular occlusive events, physicians should act promptly with an adequate and intensive anti-inflammatory treatment and brolucizumab treatment should be discontinued. It is important to note that these recommendations are primarily based on the authors' expert opinions and should be considered as guidance in managing these events rather than a formal protocol or guidelines.

[Intravitreal drug therapy for retinal vein occlusion--pathophysiological mechanisms and routinely used drugs]. / Intravitreale Medikamenteneingabe bei retinalem Venenverschluss--pathophysiologische Mechanismen und angewandte Substanzen.

The novel therapeutic principle of intravitreal drug therapy for retinal vein occlusion has become an integrated constituent of clinical practice over the last years. The two substance classes that have been evaluated in large randomised clinical trials so far are corticosteroids and inhibitors of vascular endothelial growth factor (VEGF). The reported treatment success of these intravitreally administered substances has lead not only to a paradigm shift in clinical care but has also advanced our understanding of the underlying pathophysiological principles of retinal vein occlusions. In this review the different substances are discussed, their mechanisms of action are analysed and the results of the large clinical trials available to date are critically evaluated. Furthermore, an approach to integrate these novel treatment options into the existing treatment regimes for retinal vein occlusions is suggested.

[Current situation of allocation of academic medical personnel in ophthalmology departments in Germany]. / Zum Status der Personalplanung für den ärztlichen Dienst in ophthalmologischen Hauptabteilungen in Deutschland.

BACKGROUND: At present minimum nursing staff numbers have been defined and are being implemented. In December 2019 the German Medical Association asked the German professional associations about their general experience with planning of medical personnel in hospital departments. As no structured data were available on this subject, the German Ophthalmological Society (DOG) founded a working group in March 2020 to answer this request. METHOD: In the course of several consensus meetings, the working group on personnel planning for physicians in hospitals of the DOG prepared a questionnaire on previous experiences in personnel planning of eye hospitals, which was sent to the heads of all university eye hospitals and departments of ophthalmology in Germany. The questionnaire consisted of individual items with fixed choices and free answers regarding the procedure and current situation of staffing as well as the range of tasks and organization of the medical service. RESULTS: Out of 104 departments 53 (51%) responded, of which 25 were from university departments (64% response), 23 from departments of other public or non-profit ownership (46%) and 5 from departments with private hospital ownership (33%). Of these 49% stated that there was no transparent basis for calculation of the number of medical positions in their hospital. Of the surveyed departments, outpatient tasks, services and revenues were considered in the calculations in only 47%. There was a statistically significant higher ratio of full-time personnel to the numbers of beds in university departments compared to private and publicly owned non-profit institutions (p < 0.001, t­test). All departments have to cope with multiple additional tasks in addition to clinical patient care, which are taken into account only to a limited extent in the staffing. Approximately 70% of the departments provide a 24 h/7 day (24/7) medical on-call service on site, 91% have a 24/7 surgery on-call service and 34% have a cooperation with emergency services run by the Association of Statutory Health Insurance Physicians. CONCLUSION: The results show how heterogeneously and nontransparent German departments of ophthalmology are staffed in terms of medical doctors. On average, university departments have higher personnel resources per hospital bed to cope with additional tasks in research and teaching. Outpatient tasks, which contribute significantly to the revenues of an eye department, and multiple other tasks are often not taken into account in the personnel calculation. A transparent and uniform basis for calculation of the medical staff of the departments is desirable in order to achieve a sufficient personnel staffing for a patient and employee-oriented working environment.

[Retinal damage by perfluorocarbon liquids - a question of specific gravity? Intraocular pressure peaks and shearing forces]. / Retinale Schäden durch flüssige Perfluorkarbone - eine Frage des spezifischen Gewichts? Intraokulare Druckspitzen und Scherkräfte.

BACKGROUND: Perfluorocarbon liquids (PFCL) cause retinal damage when used as long-term ocular endotamponades. Whether these changes are related to the mechanical or to the chemical properties of PFCL is unclear. The purpose of this study was to evaluate pressure spikes or shearing forces during endotamponade with PFCL and standardised eye movements. MATERIAL AND METHODS: Part 1: In an eye model the resulting pressure forces of 6 PFCL were measured at four different sites during standardised eye movements. Part 2: Shearing forces were determined in a plexiglass eye model and the resulting tangential forces at the PFCL-retina interface were calculated. Part 3: Rabbit eyes were vitrectomised and filled with light and heavy fluorocarbons for 6 weeks. Subsequently, the retina were examined histologically and by immunohistochemistry. RESULTS: With increasing filling of the eye model, the maximum of the pressure peaks moved from the inferior wall of the eye model to the lateral eye walls. For perfluorodecalin (PFD) the highest pressure peak was 407 Pa with a 75 % filling of the vitreous cavity. The lowest pressure peak was 314 Pa with a 50 % filling of hexafluoropropene oxide. Shearing forces for standardised accelerations were dependent on viscosity and ranged between 0.87 mN/m(2) (perfluorohexyloctane) and 8055 mN/m(2) (hexafluoropropene oxide). Part 3: Histological and immunohistochemical analyses did not reveal pressure-related damage or any difference between the effects of the different tamponades in vivo. CONCLUSION: In comparison with physiological dynamic and static pressure peaks, the measured mechanical forces induced by intraocular PFCL tamponades are low. Specific gravity and mechanical damage by intraocular PFCL as a cause of retinal damage seem unlikely. Animal studies underline these findings.

[YAG laser vitreolysis for treatment of symptomatic vitreous opacities]. / YAG-Laser-Vitreolyse zur Behandlung von störenden Glaskörpertrübungen.

YAG laser vitreolysis is an innovative procedure to treat symptomatic vitreous floaters. The treatment decision is based on taking a comprehensive patient history, thorough clinical examination, realistic expectations, and detailed patient information including risk of the procedure. Manifestation of vitreous opacities and possible subjective impairments are considerably variable. Dynamic changes over time are possible. Therefore, not all vitreous opacities are suitable for laser treatment. A classification according to histoanatomical origin can aid the treatment decision. In comparison to other ophthalmic YAG laser applications, YAG laser vitreolysis differs predominantly by its specific technical equipment requirements. In addition, treatment is more complex and time consuming, requires appropriate experience and knowledge of the surgeon, and should be carried out with utmost care and accuracy.

[Does the micropulse laser have an effect on chronic CSC?] / Hat der Mikropulslaser bei chronischer CCS einen Effekt?

INTRODUCTION: Central serous chorioretinopathy (CSC) is the fourth most common cause of vision loss without an evidence-based treatment recommendation. A positive effect of micropulse laser (MPL) treatment has been described in the literature in recent years. This study aimed to reappraise these results in a patient population with chronic CSC. METHODS: Patients suffering from chronic CSC with a source point detectable in fluorescein angiography (longer than 3 months duration and unresponsive to treatment with eplerenone and carbonic anhydrase inhibitors) were identified and included in this prospective and consecutive case study. Patients were controlled with a yellow laser (577 nm) after 6 weeks, 12 weeks and then every 3 months. RESULTS: A total of 28 patients were included (28 eyes). The mean duration of anamnesis was 444 days (90-1412 days) and the mean duration of the observation period after MPL was 257 days (42-909 days). The foveal retinal thickness measured 351.7 ± 82.4 µm before, compared to 253.6 ± 86.48 µm after MPL (mean of all patients over the whole observation period). Visual acuity was 0.33 ± 0.21 logMAR prior to MPL and 0.30 ± 0.22 logMAR posttreatment. Of the patients two underwent a second MPL and three patients underwent photodynamic treatment (PDT) after insufficient clinical improvement and were consequently excluded from the study. CONCLUSION: Retinal thickness in this patient population with chronic CSC was significantly reduced after MPL treatment with no significant changes of visual acuity. No side effects of MPL were observed. Larger studies including control groups are warranted to quantify the effects of MPL further.

[Macular pucker surgery with and without delamination of the internal limiting membrane-a prospective randomized study]. / Macular-Pucker-Chirurgie mit und ohne Delamination der Membrana limitans interna ­ eine prospektive randomisierte Studie.

BACKGROUND: There is evidence that additional internal limiting membrane (ILM) removal reduces the recurrence rate after pucker surgery with a similar functional outcome. On the other hand, morphological changes of the inner retinal layers after ILM peeling have been described. The aim of this study was to compare the long-term data after vitrectomy with and without ILM delamination in order to uncover possible differences in morphological and functional results. METHODS: In a prospective study of 32 patients with idiopathic epiretinal membrane, 16 patients were randomized into each of 2 groups. Both groups underwent pars plana vitrectomy (ppV) with peeling of the epiretinal membrane. In group 1 no forced additional peeling of the ILM was performed and in group 2 the ILM or ILM residues were additionally removed after staining. The investigated parameters were visual acuity, central retinal thickness (CRT) in optical coherence tomography (OCT), metamorphopsia and surgical complications. The time points of the examinations were directly preoperative, after 1, 3 and 6 months and partly 8.4 years postoperatively. RESULTS: In group 1 (n = 15) the preoperative mean visual acuity improved from 0.54 logMAR to 0.38 logMAR after 6 months postoperatively (n = 13). Of this group 6 patients could be examined in the long-term course and the visual acuity improved further to 0.32 logMAR after 8 years. The CRT decreased from 473 µm preoperatively to 235 µm in the long-term interval. In group 2 (n = 15) the mean visual acuity preoperatively was 0.47 logMAR and improved 6 months postoperatively (n = 13) to 0.38 logMAR and in the long-term examination (n = 5) to 0.1 logMAR. The CRT in this group decreased from 417 µm preoperatively to 278 µm in the long-term interval. In group 1 one recurrence occurred in the follow-up period, in group 2 none. CONCLUSION: The study showed that there was no significant difference in visual acuity and CRT between the two groups neither after 6 months nor after 8 years of follow-up. The observed recurrence in the group without ILM delamination underlines the assumption that additional ILM peeling could reduce the recurrence rate.

[Scleral buckling surgery and pneumatic retinopexy. Techniques, indications and results]. / Skleraeindellende Ablatiochirurgie und pneumatische Retinopexie. Techniken, Indikationen und Ergebnisse.

For many decades, conventional buckling surgery has been the gold standard for treating rhegmatogenous retinal detachment. The surgical technique has not changed markedly during this period; the three main buckling techniques currently used are the radial sponge, segmental sponge, and encircling band. With one of these options, an anatomic success rate of over 90% can be achieved in "simple" forms of retinal detachment. In pseudophakic eyes, however, the primary reattachment rate after buckling procedures is lower. Pneumatic retinopexy, because of its lower success rate, has not found general acceptance in Europe and is used only in selected cases. Concerning the results of the SPR study, many vitreoretinal surgeons were surprised that in the subgroup of phakic eyes, scleral buckling surgery achieved a comparable reattachment rate and better functional results even in this group of patients with complex hole configuration. This gives physicians reason to critically question the current trend of primary vitrectomy even in eyes with uncomplicated preoperative pathology and to reassess scleral buckling surgery. The longer learning curve to perform buckling surgery should be accepted. Because successful repair depends on careful preoperative examination, thorough training in binocular ophthalmoscopy skills with scleral depression should remain an essential part of the surgeon's education.

[Trends in retinal detachment surgery : What has changed compared to 2001?] / Trends in der Ablatiochirurgie : Was hat sich im Vergleich zu 2001 geändert?

INTRODUCTION: In 2001 a survey among retinal surgeons regarding the treatment of rhegmatogenous retinal detachment either with scleral buckling methods or primary vitrectomy was performed. Due to the technical progress of vitrectomy and observational systems, it seemed appropriate to renew and update this survey supplemented with current aspects. METHODS: In this study 78 vitreoretinal surgeons from German-speaking countries were surveyed via an anonymous online questionnaire on their treatment decisions for defined retinal detachment constellations. Furthermore, general aspects, such as surgical experience, timing of surgery and anesthesia were queried. The results were compared to the results of 2001. RESULTS: Only 31.1% of the surgeons had performed more than 1000 scleral buckling procedures, whereas 80.8% had performed more than 1000 primary vitrectomies, 72.7% use mainly 23 gauge, 19.5% use 20 gauge and 7.8% use 25 gauge vitrectomy systems. Of the participants 88.5% perform retinal detachment surgery also on weekends and 85.9% in emergency services. In cases of one-hole configuration 73.1% of surgeons would choose treatment with a scleral buckle and only 7.7% with primary vitrectomy. The willingness to perform scleral buckling procedure decreases with coexisting risk factors. In the presence of two adjacent retinal tears but still treatable by scleral buckling, only 56.9% would perform a conventional buckling technique but 33.3% primary vitrectomy. In a more complex retinal hole configuration but still treatable with scleral buckling elements, only 6.4% would chose scleral buckling whereas 71.8% primary vitrectomy. In comparison with the 2001 survey, there is a marked trend in retinal detachment surgery in favor of primary vitrectomy not only in pseudophakic eyes. General anesthesia was the preferred anesthesia method and in a macular-on situation nearly 50% of the responders would perform surgery on the next day. CONCLUSION: The results of our survey confirm an obvious tendency away from buckling surgery towards primary vitrectomy in the treatment of rhegmatogenous retinal detachment.

[Ultra-widefield angiography for retinal vein occlusion : How large is large enough?] / Ultraweitwinkelangiographie beim retinalen Venenverschluss : Wie groß ist groß genug?

BACKGROUND: The introduction of full fundus angiography (FAG) for retinal vein occlusion (RVO) has enriched diagnostic imaging; however, it is unclear how much of the retina has to be visualized to evaluate the risk of neovascularization. We investigated the 102° Spectralis camera to assess if imaging beyond the central 102° is necessary. METHODS: In this retrospective study we assessed 80 eyes of 80 patients with RVO to analyze central and peripheral ischemia using the ultra-widefield 102° Spectralis camera. The standard viewer software was used to delineate ischemic areas (IA) and to measure the amount of pixels of IA in correlation to the total amount of pixels in the peripheral image. RESULTS: Among the 80 eyes with RVO there were 51 eyes with ischemic areas (central and/or peripheral), of which IA could be detected in 49 eyes by analyzing a fovea-centered FAG image. The average IA in these 51 eyes was 23.5% of the total image area and 53.7% of disc areas, respectively. DISCUSSION: A fovea-centered FAG image with a 102° angle appears to be sufficient to determine the clinically relevant extent of IA. Old recommendations and imaging methods should be rethought. The 102° Spectralis camera provides a clinically suitable, fast and exact method which might replace old methods to describe and document the extent of ischemia by disc areas.

[Management of anticoagulants in ophthalmic surgery-a survey among ophthalmic surgeons in Germany]. / Umgang mit gerinnungshemmenden Substanzen in der Ophthalmochirurgie ­ eine Umfrage unter Ophthalmochirurgen in Deutschland.

INTRODUCTION: As our population ages and comorbidities rise, ophthalmic surgeons are increasingly faced with patients on anticoagulant therapy or with clotting disorders. The ophthalmic surgeon has to weigh the perioperative risk of haemorrhage when anticoagulation continues against the risk of thromboembolism caused by discontinuation or changing the patient's medication (bridging, switching, cessation). There are currently no guidelines or recommendations. METHODS: A survey was sent to the DOG (German Ophthalmologic Society) divisions and associated surgical organizations to determine the status quo. A questionnaire was sent out and filled out by the different groups of specialists. RESULTS: All four divisions of the DOG and four associated organizations returned completed questionnaires. Surgical interventions were listed that are carried out during anticoagulant therapy without exceptions, as well as interventions that were classified to require medical adjustment. Although the assessments varied, general consensus was achieved regarding interventions not requiring adjustments due to anticoagulants (i. e., intravitreal injection, cataract surgery, laser and corneal operations, simple muscle surgery), and those interventions requiring adjustments in medications (glaucoma operations, complex retina surgery, eye socket surgery, complex surgery of the lid). CONCLUSION: Main result of this survey was the specification of serious bleeding complications which are permanent vision loss and re-operation. They could serve as endpoint parameters for essential future investigations. Nevertheless, this survey makes clear that the decision about an adjustment of anticoagulant medication in ophthalmic surgery is currently made individually and not based on established standards.

Detection of Treponema pallidum in the vitreous by PCR.

BACKGROUND: Ocular involvement of syphilis still poses a clinical challenge due to the chameleonic behaviour of the disease. As the serodiagnosis has significant limitations, the direct detection of Treponema pallidum (TP) in the vitreous represents a desirable diagnostic tool. METHODS: Real-time polymerase chain reaction (PCR) for the detection of TP was applied in diagnostic vitrectomies of two patients with acute chorioretinitis. Qualitative verification of TP by real-time PCR and melting point analysis according to a modified protocol was ruled out. Patients underwent complete ophthalmological examination with fundus photographs, fluorescein angiography, serological examination, antibiotic treatment and follow-up. RESULTS: In two cases of acute chorioretinitis of unknown origin, real-time PCR of vitreous specimens of both patients provided evidence of TP and was 100% specific. Initial diagnosis of presumed viral retinitis was ruled out by PCR of vitreous specimen. Patients were treated with systemic antibiotics and showed prompt improvement in visual function and resolution of fundus lesions. CONCLUSIONS: With real-time PCR, detection of TP in the vitreous was possible and delivered a sensitive, quick and inexpensive answer to a disease rather difficult to assess. In cases of acute chorioretinitis, the use of PCR-based assays of vitreous specimens in the diagnostic evaluation of patients is advisable. Although syphilitic chorioretinitis is a rare disease, PCR should include search for TP, as diagnostic dilemmas prolong definitive treatment in a sight-threatening disease.

Evaluation of cyclophotocoagulation effects with 1310-nm contact optical coherence tomography.

PURPOSE: The aim of this pilot study was to evaluate whether contact optical coherence tomography (OCT) allows visualization of the effects of cyclophotocoagulation. METHODS: In this pilot study, transscleral contact OCT images (1310-nm wavelength) were generated prior to and immediately after conventional transscleral diode laser cyclophotocoagulation in three eyes of three patients who were suffering from uncontrolled glaucoma. RESULTS: In the region of the ciliary body, transscleral contact OCT revealed two layers: (i) a superficial thick hyperreflective complex representing conjunctiva, the Tenon capsule, episclera, and sclera; and (ii) a thinner hyporeflective layer representing the ciliary body. The ciliary body could be differentiated from the overlying sclera by its marked drop in reflectivity. After cyclophotocoagulation, a marked increase of reflectivity in the treated area of the ciliary body was identifiable. After treatment, the distinct border between the hyperreflective scleral complex disappeared, and the region of the ciliary body appeared hyperreflective. The optical properties of the overlying sclera remained unchanged. On corresponding averaged A-scan images, scleral thickness appeared to be slightly increased, whereas ciliary body thickness remained unchanged. CONCLUSIONS: This pilot study demonstrates the capability of contact OCT for allowing visualization of changes in the ciliary body after transscleral cyclophotocoagulation (TSCPC). Further investigations are planned to clarify the complete significance of these data.

[Late needling with 5-fluorouracil when scarring of filtering bleb seems imminent]. / Late Needling mit 5-Fluorouracil bei drohender Sickerkissenvernarbung.

BACKGROUND: Evaluation of needling and 5-fluorouracil (5-FU) injections more than 4 months after preceding filtration surgery. PATIENTS AND METHOD: Retrospective analysis of 17 eyes in 14 patients who underwent needling of the filtering bleb and administration of 5-FU by injection at least 4 months after trabeculectomy (TE) with mitomycin C (MMC; same surgeon throughout). Complete success was defined as a reduction of intraocular pressure (IOP) by >30% from the baseline value without further medication and, in cases of primary open-angle glaucoma, IOP of 18 mmHg. The mean period of follow-up was 8.1 months (3-24 months). RESULTS: One to four needlings (Ø 1.6) with one to five injections (Ø 3.1) of 5-FU were performed as required according to clinical need an average of 31.3 months (4-108 m) after TE. The mean baseline IOP was 25 mmHg (+/-SD 6.02; median 25 mmHg). After needling and 5-FU injection the mean IOD at the last hospital visit was 13.64 mmHg (+/-SD 5.2, median 13 mmHg; p<0,001). Complete success was achieved in 82.4% of these cases. The mean reduction in IOP was 11.2 mmHg (0-22 mmHg). In the cases with successful outcome (14 of 17 eyes) the mean IOP reduction from baseline was 55%. Three eyes required further treatment. Complications encountered were hyphaema (2 cases), subconjunctival bleeding (1 case) and corneal erosion (3 cases). CONCLUSION: Late needling and injections of 5-FU can restore filtering bleb function even over 4 months after initial surgery. The high success rate and low incidence of complications together with the simple procedure justify regarding this approach as an alternative that can be used before passing on to more invasive interventions.