Outcomes of Surgical Bleb Revision for Late-onset Bleb Leaks After Trabeculectomy

Lin, Albert P.; Chung, Juliet E.; Zhang, Kevin S.; Chang, Michelle M.; Orengo-Nania, Silvia; Gross, Ronald L.; Chang, Peter

doi:10.1097/ijg.0b013e31821e83e6

Cited by 15 publications

(10 citation statements)

References 17 publications

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“…Such blebs need to be revised, and this was initially performed by the excision of the bleb and conjunctival replacement, 14,15 or more recently by the ablation of the bleb surface by scraping and cautery, together with conjunctival replacement. [16][17][18][19][20] However, a high percentage of eyes had an increased IOP and frequent postoperative complications reported with both these procedures in retrospective studies (Table 3). 14,15,17,20 In our study, the mean IOP preoperatively was 5.8 ± 4.2 mm Hg and was found to be 12.6 ± 3.9 mm Hg at the 24-month follow-up, with 5.8% of the eyes on a single glaucoma medication at the last review.…”

Section: Discussionmentioning

confidence: 92%

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The Long-term Outcome of Primary “Bleb-sparing, Epithelial Exchange” in Dysfunctional Filtering Blebs

Sihota

Angmo²,

Sen³

et al. 2016

Journal of Glaucoma

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Section: Discussionmentioning

confidence: 92%

“…Additional surgery was required in 10% of the eyes. 16 Bleb parameters were evaluated using IBAGS in our study. 22 Filtering blebs were found to maintain their limbal extent, but showed a significant decrease in the bleb height, without any eye progressing to a flat bleb.…”

Section: Discussionmentioning

confidence: 99%

The Long-term Outcome of Primary “Bleb-sparing, Epithelial Exchange” in Dysfunctional Filtering Blebs

Sihota

Angmo²,

Sen³

et al. 2016

Journal of Glaucoma

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“…Other surgical approaches such as bleb excision and conjunctival autograft or advancement techniques report success rates as high as 75%, although additional medication or surgery are frequently needed to control glaucoma. 24,49 Pedicle flaps, conjunctival advancement, or autologous graft with bleb excision techniques may be similarly successful; however, patients may need multiple surgical interventions. 50 Bleb reconstruction involving resection of the bleb and rotational conjunctival flap has also been reported to stop the leak in approximately 80% of cases; however, medical therapy is needed in approximately one-half of patients.…”

Section: Intra-and Peri-operative Use Of Mitomycin-c (Mmc)mentioning

confidence: 99%

Incision-Free Minimally Invasive Conjunctival Surgery (MICS) for Late-Onset Bleb Leaks After Trabeculectomy (An American Ophthalmological Society Thesis)

Gupta

2019

American Journal of Ophthalmology

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This study describes an incision-free minimally invasive conjunctival surgical (MICS) technique to repair late-onset leaking blebs after trabeculectomy. METHODS: A surgical technique to repair leaking blebs without incision or excision of conjunctiva is described. This is followed by retrospective review of all patients treated at the Glaucoma Unit at St. Michael's Hospital for bleb leaks repaired with MICS from 2012 to 2017. With Research Ethics Board approval, clinical data obtained from the charts included demographic information, vision, intraocular pressure (IOP) data before and after surgery, need for additional medication, and complications. Resolution of the bleb leak without the need for additional therapy or intervention for glaucoma control was considered a success. RESULTS: The MICS approach was applied to 14 eyes of 13 consecutive patients with a leaking bleb. Mean age of presentation was 70.2 ± 14.8 years, and all patients had a history of mitomycin use at the time of glaucoma surgery. The onset of bleb leak following trabeculectomy ranged from 7 months to 16.3 years. Mean pre-operative IOP was 4.5 ± 2.8 mm Hg; IOP measured 12.3 ± 3.0 mm Hg immediately after the procedure. Complete resolution of the bleb leak was observed following surgery in all cases. The follow-up period ranged from 2 weeks to 61 months (10.2 ± 18.1). Recurrent bleb leak was reported in 1 patient 2 years following initial surgery. In all cases, the initially repaired filtering blebs remained functional at last followup, and no additional medications were required. CONCLUSIONS: The MICS procedure is an effective option for treating late-onset leaking blebs without cutting or excising conjunctival tissue. The minimal requirements of this method make it additionally accessible to low-resource settings. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

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“…21,22 With a late bleb leak, surgical repair is considered more effective than conservative measures. 20,23 Ultimately, it is important to emphasise the careful use of non-toothed forceps for handling the conjunctiva; blunt dissection; round-bodied suturing to help reduce conjunctival buttonholes and suture holes; and the avoidance of aggressive use of MMC or 5-FU.…”

Section: Bleb Overdrainagementioning

confidence: 99%

Trabeculectomy – Prevention and Management of Complications

Sousa¹,

Pinto²

2018

European Ophthalmic Review

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Modern trabeculectomy remains the gold-standard surgical option in glaucoma, with excellent long-term success rates and relatively low serious complication rates. However, these improved outcomes imply a careful preoperative risk stratification, a meticulous intraoperative technique and watchful postoperative care. This review discusses some trabeculectomy-related complications and various strategies to prevent or treat these conditions.

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Outcomes of Surgical Bleb Revision for Late-onset Bleb Leaks After Trabeculectomy

Abstract: Bleb revision showed a high success rate. About two-thirds of eyes required medication, 10% of eyes required additional glaucoma surgery, and there was a low risk for bleb-related infection following bleb revision.

Cited by 15 publications

References 17 publications

The Long-term Outcome of Primary “Bleb-sparing, Epithelial Exchange” in Dysfunctional Filtering Blebs

The Long-term Outcome of Primary “Bleb-sparing, Epithelial Exchange” in Dysfunctional Filtering Blebs

Incision-Free Minimally Invasive Conjunctival Surgery (MICS) for Late-Onset Bleb Leaks After Trabeculectomy (An American Ophthalmological Society Thesis)

Trabeculectomy – Prevention and Management of Complications

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