Autologous blood injection for marked overfiltration early after trabeculectomy with mitomycin C

Okada, Koji; Tsukamoto, Hisao; Masumoto, M.; Jian, Koji; Okada, Mayumi; Mochizuki, Hideki; Mishima, Hiromu K.

doi:10.1034/j.1600-0420.2001.790320.x

Cited by 14 publications

(6 citation statements)

References 18 publications

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“…While innovations in MMC dosage and application have improved bleb morphology, bleb-related complications are still seen. Nonsurgical methods of bleb revision include injection of autologous blood serum to stimulate scarring and thereby reduce bleb height, but studies have reported variable results [15][16][17][18][19][20] and complications, including bleb failure, have been reported with this technique. [21][22][23][24] Laser treatments have been used but may require multiple sessions that can induce inflammation and ultimately lead to less predictable IOP control.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of the study eyes were from White patients (13 eyes, 54.5%), while Black (5 eyes, 21.7%), Hispanic (4 eyes, 17.4%), and Asian (1 eye, 4.3%) eyes comprised the remaining participants. Reasons for ologen revision included persistent bleb leak with low IOP (18), dysesthesia (3), and an overfiltering bleb (2). Two eyes with dysesthesia and one eye with a bleb leak also demonstrated an overhang of the avascular bleb onto the cornea.…”

Section: Baseline Characteristicsmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Baseline Characteristicsmentioning

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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“…Okada et al performed peri-bleb injections of autologous blood in five eyes with excess filtration and hypotony after trabeculectomy, but without hypotony maculopathy. After a mean 31-month follow-up, all eyes had well-controlled IOP while visual acuity in three eyes was much improved [39]. Due to small sample size and no rigorous methodology, further research is needed to establish the best surgical approach for these patients and the long-term outcomes.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Phacoemulsification on Intraocular Pressure in Eyes with Hyperfiltration Following Trabeculectomy: A Prospective Study

et al. 2017

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Introduction: The aim of this study was to evaluate the effect of visually non-significant cataract extraction in patients with hypotony maculopathy and reduced visual acuity due to over-filtering blebs after trabeculectomy. Methods: Patients with intraocular pressure (IOP)\6 mmHg and documented hypotony maculopathy due to over-filtering blebs after trabeculectomy were prospectively recruited. Eligible patients underwent visually non-significant cataract phacoemulsification, no earlier than 12 weeks from the diagnosis of hypotony maculopathy. IOP and visual acuity before and after phacoemulsification were compared at 1 and 3 months from surgery. Correlations between age, time interval between surgeries, baseline IOP, bleb type and IOP and visual acuity changes at 3 months after phacoemulsification were investigated. Results: From January 2010 to September 2014, 20 consecutive adult patients met the inclusion criteria. Before phacoemulsification, mean IOP was 3.1 ± 1.6 mmHg. Following phacoemulsification, mean IOP increased to 8.6 ± 4.1 mmHg at 1 month (p\0.01) and to 9.1 ± 4.3 mmHg at 3 months (p\0.01). IOP elevation following phacoemulsification was observed in 16 of 20 eyes (80%). Mean visual acuity improved from Snellen 0.5 ± 0.1 to 0.6 ± 0.1 at 1 month (p\0.01) to 0.7 ± 0.2 at 3 months (p\0.01) after phacoemulsification. In 4 eyes in which the IOP was not elevated, surgical revision of the previous trabeculectomy was performed. No significant correlations between investigated variables, visual acuity and IOP changes at 3 months after phacoemulsification were found. Conclusion: Phacoemulsification of visually non-significant cataract appears to be a safe and effective technique for managing chronic ocular hypotony with deep anterior chamber due to over-filtering blebs.

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“…Maculopathy due to hypotony is a rare complication of glaucoma filtering surgery, trauma, and other anterior segment procedures. It was uncommon prior to the advent of adjunctive antifibrotic agents for glaucoma surgery [6,7].…”

Section: Introductionmentioning

confidence: 99%

Ocular Hypotony after Glaucoma Surgery

Ghobashy¹,

Elmaria²,

Ghoneim³

et al. 2022

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Background: Postoperative hypotony is associated with choroidal effusion, suprachoroidal haemorrhage, aqueous misdirection syndrome (malignant glaucoma), choroidal folds and hypotony maculopathy, anterior chamber (AC) shallowness or loss and subsequent failure of the original filtration of procedure. This work aimed to study the causes, risk factors, adverse effects, and management plans of ocular hypotony after different glaucoma surgeries. Methods: This retrospective study was carried out on 205 eyes underwent glaucoma surgery with follow up for more than 3 months. Patients were divided into two groups: 30 cases were diagnosed with post-operative hypotony, 175 eyes were without hypotony. Patients were subjected to glaucoma diagnosis, type of glaucoma operation and recorded IOP for 3 months at least. Results: CPC, Visco-Trab, Phaco Visco-Trab Visco and express valve were significantly different between the two groups (P=0.049, P=0.012, P=0.043 and P<0.001 respectively) and other types of operation were insignificantly different between the two groups. IOP was significantly decreased at first diagnosis of hypotony and at last follow up compared to before operation (P value <0.001). IOP at last follow up was significantly increased compared to first diagnosis of hypotony (P value <0.001). Criteria of hypotony eyes were insignificantly different between patients needed surgical intervention and no surgical intervention. Conclusions: Postoperative hypotony was most common in pseudo-exfoliative glaucoma cases compared to other glaucoma types. While the most type of glaucoma surgery that was associated with postoperative hypotony was viscocanalostomy combined with express shunt. The adverse effects reported in our study were choroidal effusion and hypotony maculopathy.

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Autologous blood injection for marked overfiltration early after trabeculectomy with mitomycin C

Cited by 14 publications

References 18 publications

Outcomes of bleb revision with ologen following filtering glaucoma surgery

Outcomes of bleb revision with ologen following filtering glaucoma surgery

The Effect of Phacoemulsification on Intraocular Pressure in Eyes with Hyperfiltration Following Trabeculectomy: A Prospective Study

Ocular Hypotony after Glaucoma Surgery

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