Outcomes of Surgical Bleb Revision for Complications of Trabeculectomy

• Published in: Ophthalmology (Rochester, Minn.) Vol. 116; no. 9; pp. 1713 - 1718
• Main Authors: Radhakrishnan, Sunita, MD, Quigley, Harry A., MD, Jampel, Henry D., MD, MHS, Friedman, David S., MD, PhD, Ahmad, Sameer I., MD, Congdon, Nathan G., MD, McKinnon, Stuart, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2009; Elsevier
• Subjects: Aged; Biological and medical sciences; Blister - etiology; Blister - surgery; Female; Follow-Up Studies; Glaucoma - surgery; Humans; Intraocular Pressure - physiology; Male; Medical sciences; Miscellaneous; Ocular Hypotension - etiology; Ocular Hypotension - surgery; Ophthalmology; Paresthesia - etiology; Paresthesia - surgery; Reoperation; Retrospective Studies; Surgical Wound Dehiscence - etiology; Surgical Wound Dehiscence - surgery; Surgically-Created Structures; Trabeculectomy - adverse effects; Treatment Outcome; Visual Acuity - physiology; Trabeculectomy; Prognosis; Treatment; Revision; Surgery; Complication; Evolution; Ophthalmology
• ISSN: 0161-6420; 1549-4713
• DOI: 10.1016/j.ophtha.2009.04.003

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.