Bleb revision for hypotony and leaks following trabeculectomy

Purpose: To evaluate the safety and effectiveness of surgical bleb revision, consisting of excision of the bleb and resuturing of the conjunctival wound, in the management of hypotony and bleb leaks following trabeculectomy. Methods: Retrospective chart review of all bleb revisions performed between 1/93 and 6/96. Results: Nineteen cases were identified, of which full information was obtained on 18. Average age was 65 years (SD±15), 9 patients were women. Bleb revision was preceded by trabeculectomy in 13 cases, combined cataract extraction and trabeculectomy in 3, and cataract extraction alone (inadvertent bleb with hypotony) in 2. Indications for intervention included bleb leaks in 13 cases, hypotony (IOP <5 with secondary complications) in 11, and an overhanging bleb in 1 - Average follow-up was 21 months (SD±13, range 3-43). Average pre-operative IOP was 4.4 mmHg (SD±5.7), post-op IOP 11.5 mmHg (SD±4.0), and average number of IOP medications at last follow-up 0.72 (SD±1 1). Final visual acuity was improved (>2 lines) in 9 patients, unchanged ir. 8, and worse (>2 lines) in 1. Complications included persistent leak for more than 1 week (6 (none Seidel positive at last follow up)), and loss of IOP control (7 patients on IOP medications at last follow-up). Two patients underwent later cataract extraction, and in one patient (not included in above), bleb revision was attempted but not able to be performed; this was the only patient requiring repeat trabeculectomy Conclusions: Surgical bleb revision is an effective method for the management of bleb leaks and hypotony following trabeculectomy.

Duke Scholars

Author Leon Walker Herndon Jr. Ophthalmology, Glaucoma