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Outcomes of surgical bleb revision for complications of trabeculectomy.

Publication ,  Journal Article
Radhakrishnan, S; Quigley, HA; Jampel, HD; Friedman, DS; Ahmad, SI; Congdon, NG; McKinnon, S
Published in: Ophthalmology
September 2009

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.

Duke Scholars

Published In

Ophthalmology

DOI

EISSN

1549-4713

Publication Date

September 2009

Volume

116

Issue

9

Start / End Page

1713 / 1718

Location

United States

Related Subject Headings

  • Visual Acuity
  • Treatment Outcome
  • Trabeculectomy
  • Surgically-Created Structures
  • Surgical Wound Dehiscence
  • Retrospective Studies
  • Reoperation
  • Paresthesia
  • Ophthalmology & Optometry
  • Ocular Hypotension
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Radhakrishnan, S., Quigley, H. A., Jampel, H. D., Friedman, D. S., Ahmad, S. I., Congdon, N. G., & McKinnon, S. (2009). Outcomes of surgical bleb revision for complications of trabeculectomy. Ophthalmology, 116(9), 1713–1718. https://doi.org/10.1016/j.ophtha.2009.04.003
Radhakrishnan, Sunita, Harry A. Quigley, Henry D. Jampel, David S. Friedman, Sameer I. Ahmad, Nathan G. Congdon, and Stuart McKinnon. “Outcomes of surgical bleb revision for complications of trabeculectomy.Ophthalmology 116, no. 9 (September 2009): 1713–18. https://doi.org/10.1016/j.ophtha.2009.04.003.
Radhakrishnan S, Quigley HA, Jampel HD, Friedman DS, Ahmad SI, Congdon NG, et al. Outcomes of surgical bleb revision for complications of trabeculectomy. Ophthalmology. 2009 Sep;116(9):1713–8.
Radhakrishnan, Sunita, et al. “Outcomes of surgical bleb revision for complications of trabeculectomy.Ophthalmology, vol. 116, no. 9, Sept. 2009, pp. 1713–18. Pubmed, doi:10.1016/j.ophtha.2009.04.003.
Radhakrishnan S, Quigley HA, Jampel HD, Friedman DS, Ahmad SI, Congdon NG, McKinnon S. Outcomes of surgical bleb revision for complications of trabeculectomy. Ophthalmology. 2009 Sep;116(9):1713–1718.
Journal cover image

Published In

Ophthalmology

DOI

EISSN

1549-4713

Publication Date

September 2009

Volume

116

Issue

9

Start / End Page

1713 / 1718

Location

United States

Related Subject Headings

  • Visual Acuity
  • Treatment Outcome
  • Trabeculectomy
  • Surgically-Created Structures
  • Surgical Wound Dehiscence
  • Retrospective Studies
  • Reoperation
  • Paresthesia
  • Ophthalmology & Optometry
  • Ocular Hypotension