LAUSR

THE INTERESTING ARTICLE BY HIRUNPATRAVONG AND associates has demonstrated a very good technique that is less frequently reported and saves conjunctiva for future interventions.We have a few concerns regarding the study, which we would like to raise with the authors, and we would also like to share our own experience. The inclusion criteria mention intraocular pressure (IOP) consistently above the target on maximum tolerated medication or glaucomatous progression with evidence of visual field or optic nerve worsening. We prefer to do bleb needling (BN) in such cases. We have encountered fair short-term success rates with fewer complications in our patients. The authors used limbal as well as fornixbased conjunctival flap. Were there any specific criteria for choosing either type of technique? Were any flaprelated complications encountered, especially in patients who were operated several years after surgery? Baseline IOP of the patients ranged from 9.0 to 37 mm Hg. An IOP of 9 mm Hg is very low and reducing the IOP further can cause hypotony. We would like to know the reason for taking such low-IOP patients for repeat surgery. The success rate mentioned in the present study is reasonably good. We feel that this technique can be tried as a second procedure after needling fails. However, it is not very convincing to perform a third trabeculectomy at the same site after failure of 2 consecutive trabeculectomies, as was done in 6 cases. Being a tertiary eye care center, we also encounter many failed trabeculectomies. We have done BN and repeat trabeculectomy (RT) with mitomycin C (MMC) in failing blebs (unpublished data). Ten patients underwent repeat trabeculectomy and 12 patients underwent BN. It was a heterogeneous group with diagnosis of