[Mitomycin C versus 5-FU in failing blebs needling].

Please allow me to express my congratulations to the team led by Dr. Esperanza Gutiérrez for the results obtained in the recently published article titled «Repermeabilization through revision with filtration bleb needling with late failure after glaucoma surgery» (1). Although the results are obtained from a retrospective study, with the limitations this may entail, they achieve a high success rate in previously failed blebs, with a mean time from filtrating surgery to revision with 5-FU of 67,3 months, including one failed case 23 years after surgery. In said study the authors explain, from a descriptive statistical viewpoint, the time elapsed from surgery to the bleb failure, which seems not to have significant relevance. In other papers, if said interval is shorter, it is considered as one of the factors which most contributes to the success of repermeabilization, to the extent of being included in the patient selection criteria. Personally, I stopped utilizing 5-FU many years ago due to the epithelial complications, the subjective irritation it caused patients and the need for retreatment (2,3). In our personal experience, we obtained better results with Mitomycin C associated to needle manipulation in cases where it hadn’t been used intraop, thus reducing the risk of cadaveric blebs (4). However, in said article complications are less frequent and severe than those of other published series. Taking into account the seriousness which characterizes this glaucoma workgroup of the 12 de Octubre Hospital, this leads other ophthalmologists (including myself) to reconsider performing bleb revisions with 4-FU in late failures (1). To end, I reiterate my gratitude to this group for continuing to work along the line which signifies a great contribution to those of us who daily endure the shockwaves of glaucoma surgery and its frequently unforeseen and difficult postops, adding that we all need more prospective dual arm studies with both anti-fibroblasts in order to assess long term results.