Outcomes of surgical bleb revision for complications of trabeculectomy.

Abstract

OBJECTIVE:

To describe the results of revision surgery for complications of trabeculectomy in a case series from an academic glaucoma service.

DESIGN:

Retrospective case series.

PARTICIPANTS:

A total of 177 eyes of 167 adult patients who underwent revision of trabeculectomy at the Wilmer Eye Institute between 1994 and 2007.

METHODS:

Three indications for surgery were identified: hypotony without leak, bleb leak, and bleb dysesthesia. Revision was deemed successful when all of the following were true: the primary indication was eliminated, further intraocular pressure (IOP)-lowering surgery was not required, no major complication occurred, and a new bleb-related problem did not develop. Patients with less than 3 months of follow-up were excluded unless failure occurred earlier. Surgical procedures included variations on excision of thin or leaking conjunctiva with advancement.

MAIN OUTCOME MEASURES:

Change in IOP, change in visual acuity, need for further IOP-lowering surgery, and complications after bleb revision.

RESULTS:

Subjects' mean age was 67+/-14 years, 54% were female, and mean follow-up was 2.8+/-2.7 years, with a mean interval from trabeculectomy to revision of 3.5+/-3.7 years. Overall success rate was 63% (112/177), which was slightly higher for leak repair (65%; 64/98) and hypotony (63%; 32/51) than for dysesthesia (57%; 16/28) indications. By Kaplan-Meier analysis, overall cumulative success rates at 1, 2, 5, and 10 years after bleb revision were 80%, 75%, 50%, and 41%, respectively. IOP and visual acuity improved significantly in both hypotony and leak groups (P values ranging from 0.004 to <0.0001). Additional IOP-lowering surgery was required in 9%. In multivariate regression analysis adjusting for age, gender, and number of prior surgeries, patients with glaucoma other than primary open-angle glaucoma were twice as likely to have failed bleb revision.

CONCLUSIONS:

Surgical bleb revision often provides successful resolution of bleb-related complications. Most patients maintain IOP control without need for further IOP-lowering surgery.

FINANCIAL DISCLOSURE(S):

Proprietary or commercial disclosure may be found after the references.

• Authors: Sunita Radhakrishnan, Harry A Quigley, Henry D Jampel, David S Friedman, Sameer I Ahmad, Nathan G Congdon, Stuart McKinnon
• Journal: Ophthalmology (Ophthalmology) Vol. 116 Issue 9 Pg. 1713-8 (Sep 2009) ISSN: 1549-4713 [Electronic] United States
• PMID: 19643490 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Topics

• Aged
• Blister (etiology, surgery)
• Female
• Follow-Up Studies
• Glaucoma (surgery)
• Humans
• Intraocular Pressure (physiology)
• Male
• Ocular Hypotension (etiology, surgery)
• Paresthesia (etiology, surgery)
• Reoperation
• Retrospective Studies
• Surgical Wound Dehiscence (etiology, surgery)
• Surgically-Created Structures
• Trabeculectomy (adverse effects)
• Treatment Outcome
• Visual Acuity (physiology)