Algorithm approach for revision surgery following late-onset bleb complications
            after trabeculectomy: long-term follow-up

Pérez, Carolina Alejandra; Oportus, María J.; Mellado, Felipe; Valenzuela, Felipe; Cartes, Cristián; López-Ponce, D.; Salinas-Toro, Daniela; López‐Solís, Remigio; Traipe, Leonidas

doi:10.5935/0004-2749.20170008

Cited by 7 publications

(6 citation statements)

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“…The balance of aqueous may have been established such that despite no leak was present, IOP remained low. In contrast to surgical intervention, 24,25 which may lead to subconjunctival scarring that impede filtration and thus may cause IOP elevation, CXL does not result in an increase in IOP. This is particularly important in eyes with advanced glaucoma.…”

Section: Discussionmentioning

confidence: 98%

Prospective study on a novel treatment for leaking cystic bleb: Efficacy and safety of collagen crosslinking

Cai

Choy

Zhu

et al. 2019

Clinical Exper Ophthalmology

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Importance Management of cystic bleb leak is difficult. It would be essential to look for a method to strengthen the original pathological conjunctiva and reverse bleb leak. Background To evaluate the long‐term efficacy and safety of collagen crosslinking in patients with leaking cystic bleb. Design Prospective interventional case series at a university‐based hospital. Participants Twelve eyes in 12 subjects with late‐onset bleb leak from cystic bleb, without indications for prompt surgical interventions were included. Methods The subjects underwent crosslinking with 0.1% riboflavin application to bleb surface, followed by ultraviolet irradiation for 30 minutes. The subjects were followed up at baseline and at 1 week, 1 month, 3 months, 6 months post‐treatment and then every 6 months afterwards. Main Outcome Measures Interval from treatment to cessation of bleb leak, recurrence rate of bleb leak and side effects of treatment. Results The mean follow‐up after crosslinking was 29.33 ± 12.45 months. Bleb leak subsided in 11 (92%) of 12 patients after a single session of crosslinking, after 1 to 8 weeks (median 3 weeks). Time to leak cessation was significantly correlated with the number of prior glaucoma interventions (R = .71, P = .014). Bleb wall at 3 months was significantly thicker than at baseline (0.70 ± 0.67 vs 0.81 ± 0.62 mm, P = .008). None of the patients experienced any complications. Conclusions and Relevance Crosslinking achieves resolution of cystic bleb leak which lasts for at least 12 months, without the need of subsequent surgical interventions. Crosslinking is a simple, non‐invasive treatment for bleb leak. It aims to restore the integrity of conjunctiva.

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Section: Discussionmentioning

confidence: 98%

Prospective study on a novel treatment for leaking cystic bleb: Efficacy and safety of collagen crosslinking

Cai

Choy

Zhu

et al. 2019

Clinical Exper Ophthalmology

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“…Complete success was seen in 60% (16 eyes) while qualified success was seen in 80% (24 eyes). Perez et al 42 also evaluated 23 eyes undergoing bleb revision for hypotony maculopathy (47.8%), bleb leak (30.4%), and dysesthetic bleb (21.7%). In this series, the success rate was 65.2% at 48 months, with the primary outcome measure being resolution of the main surgical indication, no additional surgery for IOP control, and an IOP ≥6 mmHg and ≤18 mmHg.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of bleb revision with ologen following filtering glaucoma surgery

Kornmann

Fellman

Smith

et al. 2021

European Journal of Ophthalmology

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Purpose This study reports long-term outcomes of bleb revision with ologen™ Collagen Matrix (Aeon Astron Europe BV, the Netherlands) for the surgical management of various bleb-related issues including persistent bleb leaks with or without associated hypotony, bleb dysesthesia, overhanging blebs, or hypotony after filtering glaucoma surgery. Materials and methods A retrospective chart review was performed for patients who underwent ologen bleb revision from 2012 to 2019 at Glaucoma Associates of Texas. Results The study included 23 eyes of 22 patients undergoing bleb revision with the ologen implant. Mean age was 74.0 ± 11.3 years, 16 (69.6%) were female, and 13 (56.5%) were White. Indications for bleb revision included bleb leak (78.3%), dysesthesia (13.0%), and hypotony from an overfiltering bleb (8.7%). Mean preoperative intraocular pressure was 6.8 ± 4.1 mmHg and the number of medications was 0.3 ± 0.9. Median follow-up was 24 months (range: 12–84 months); all patients had at least 12 months of follow-up. At 1 year, mean intraocular pressure was 10.9 ± 4.6 mmHg on 0.2 ± 0.5 medications, and at last follow-up, mean intraocular pressure was 10.4 ± 3.6 mmHg on 0.3 ± 0.7 medications. Bleb morphology remained low, diffuse, and posterior. One patient developed kissing choroidal effusions requiring surgical drainage with subsequent stabilization of intraocular pressure and bleb function, and three patients required additional surgery due to persistent leaks or bleb failure; there were no other vision-threatening complications. Conclusions Use of the ologen implant during surgical bleb revision is a useful surgical technique that confers long-term improvements in bleb morphology and stability of function.

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“…35,39 Multiple studies have demonstrated improvements in visual outcome with bleb revision for hypotony maculopathy. 35,39,40 There is no standardized technique for approaching revision surgery, but the process usually involves mobilizing the conjunctiva, lysing the episcleral adhesions, and possibly suturing the scleral flap to adjust aqueous flow. Perez et al 39 described a surgical algorithm for blebrelated complications based on assessment of conjunctival health and filtration at the scleral flap.…”

Section: Surgical Techniquementioning

confidence: 99%

“…[35][36][37][38] Interestingly, several studies have noted that the survival rate of revision surgery was dependent on the indication for surgery, with higher success when it was due to bleb leaks and hypotony (57% to 65% and 60% to 63%, respectively) compared with uncontrolled IOP (44%). 35,39 Multiple studies have demonstrated improvements in visual outcome with bleb revision for hypotony maculopathy. 35,39,40 There is no standardized technique for approaching revision surgery, but the process usually involves mobilizing the conjunctiva, lysing the episcleral adhesions, and possibly suturing the scleral flap to adjust aqueous flow.…”

Section: Surgical Techniquementioning

confidence: 99%

“…Interestingly, several studies have noted that the survival rate of revision surgery was dependent on the indication for surgery, with higher success when it was due to bleb leaks and hypotony (57% to 65% and 60% to 63%, respectively) compared with uncontrolled IOP (44%) 35,39 . Multiple studies have demonstrated improvements in visual outcome with bleb revision for hypotony maculopathy 35,39,40 …”

Section: Introductionmentioning

confidence: 99%

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A Brief Review of Historical and Current Trends in Trabeculectomy

Pham,

Lees,

Gutkind

2023

International Ophthalmology Clinics

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Algorithm approach for revision surgery following late-onset bleb complications after trabeculectomy: long-term follow-up

Abstract: An algorithm approach for the surgical management of late-onset bleb complications with a success rate similar to those reported in specialized literature is proposed. Randomized trials are needed to confirm the best surgical approach.

Cited by 7 publications

References 0 publications

Prospective study on a novel treatment for leaking cystic bleb: Efficacy and safety of collagen crosslinking

Prospective study on a novel treatment for leaking cystic bleb: Efficacy and safety of collagen crosslinking

Outcomes of bleb revision with ologen following filtering glaucoma surgery

A Brief Review of Historical and Current Trends in Trabeculectomy

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