Late Fistulization of Operative Wounds

Dunnington, John H.; Regan, Ellen F.

doi:10.1001/archopht.1950.00910010416001

Cited by 24 publications

(8 citation statements)

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“…7 Advancement of conjunctiva from the adjacent conjunctiva, Tenon layers, 8,9,[14][15][16][17][18] or both and free conjunctival autografts 19,20 been described in the literature, there are no studies that examine the indications for, and outcomes of, this technique. 16,17,21 In addition, no articles have been written describing the indications and outcomes of conjunctival advancement for late-onset filtering bleb leaks since the advent of trabeculectomy with adjunctive antifibrotic agents.…”

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confidence: 99%

“…7,8 Complications of late-onset filtering bleb leaks include decreased visual acuity (related to hypotony, corneal folds, or maculopathy), shallow or flat anterior chamber, and chronic tearing. 9 In addition, filtering bleb leaks have been implicated in bleb-related infections (blebitis or endophthalmitis). 10-13 Figure 1 shows an example of a thin, ischemic filtering bleb with surrounding hyperemia from a Staphylococcus aureus bleb infection.…”

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Conjunctival Advancement for Late-Onset Filtering Bleb Leaks

Budenz¹

1999

Arch Ophthalmol

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To determine the indications and outcome of conjunctival advancement surgery for late-onset filtering bleb leaks.Patients and Methods: Retrospective medical record review of a consecutive case series of all patients who underwent conjunctival advancement surgery for persistent late-onset glaucoma filtering bleb leaks at a tertiary referral center between December 1, 1985, and April 30, 1997.Main Outcome Measures: Indications for surgery, preoperative and postoperative intraocular pressure (IOP), visual acuity, status of bleb leak, and need for reinstitution of medical therapy or reoperation for glaucoma.Results: Twenty-six eyes of 26 patients were analyzed. Complications from bleb leaks that necessitated surgical intervention included chronic ocular hypotony (n = 21), decreased visual acuity (n = 9), bleb-related infection (n = 11), hypotony maculopathy (n = 4), corneal edema with folds (n = 7), choroidal effusion (n = 3), and

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Conjunctival Advancement for Late-Onset Filtering Bleb Leaks

Budenz¹

1999

Arch Ophthalmol

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“… 14 , 15 When conservative management fails, surgical management is required. Dunnington and Regan 17 described a series of 15 patients with either inadvertent or intentional filtering blebs who underwent conjunctival advancement for bleb leaks. Geijin et al 25 described a success rate of 86.1% for 36 patients who underwent excision of conjunctiva and advancement of conjunctiva and Tenon capsule for bleb leaks or overfiltrating bleb.…”

Section: Discussionmentioning

confidence: 99%

“… 10 - 13 However, these procedures have a limited success rate. 14 , 15 Effective treatment of hypotony often requires surgical management, 16 usually by advancement of conjunctiva from the adjacent conjunctiva and/or Tenon layers 17 - 25 or by free conjunctival autografts. 26 , 27 The goal of surgery is to seal bleb leaks and overfiltration while preserving a functioning filtering bleb, and several studies have reported that surgical management has a 83-96% success rate, although success was defined differently in each study.…”

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Effect of Excision of Avascular Bleb and Advancement of Adjacent Conjunctiva for Treatment of Hypotony

Lee

Hyung

2009

Korean J Ophthalmol

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PurposeTo evaluate the efficacy of excision of avascular bleb and advancement of adjacent conjunctiva (EBAC) for treatment of hypotony after trabeculectomy with mitomycin C (MMC).MethodsFifteen patients (17 eyes) who received EBAC for correction of hypotony between September 1996 and October 2008 were reviewed retrospectively. The main outcomes were intraocular pressure (IOP) and postoperative complications.ResultsHypotony (IOP <6 mmHg) of eight eyes (47.1%, seven patients) was caused by bleb perforation. Of these, two eyes (two patients) had a history of trauma. Hypotony appeared at 33.9±30.8 months, and EBAC was performed at 48.2±35.3 months after trabeculectomy with MMC. The mean follow-up period was 38.3±29.8 months. The qualified success rate of EBAC was 100% at 51 months after EBAC, and the complete success rate of EBAC was 76.5% at six months and 70.6% at 51 months, as determined by Kaplan-Meier analysis. Post-EBAC complications included blepharoptosis in four eyes (23.5%) and bleb perforation in one (5.9%). The blepharoptosis resolved within one month after EBAC in two patients. However, in the other patients, mild blepharoptosis remained at 17 and 22 months postoperatively.ConclusionsEBAC was found to be an effective method for treatment of hypotony after trabeculectomy with MMC, and postoperative blepharoptosis was a major complication.

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“…This improves the early surgical outcome, but appears to increase the likelihood of late bleb leaks (Lamping et al, 1986;Wilensky, 1992;Chen et al, 1997;Scott et al, 1998). A number of modalities exist to treat bleb leaks (Gehring and Ciccarelli, 1972;Awan and Spaeth, 1974;Joiner et al, 1989;Pederson, 1989;Weber and Baker, 1989), including surgical procedures such as conjunctival patch grafts (Wilson and Kotas-Neumann, 1994), and scleral patch grafts in association with conjunctival advancement (Dunnington, 1950;Melamed et al, 1991;O'Connor et al, 1992;Morris et al, 1998). The reason for the existence of many different procedures to reverse bleb leaks is the fact that none is a cure in all cases.…”

Section: Introductionmentioning

confidence: 99%

Matrix metalloproteinase gelatinase B (MMP-9) is associated with leaking glaucoma filtering blebs

Chintala¹,

Wang²,

Diskin³

et al. 2005

Experimental Eye Research

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The goal of glaucoma filtering surgery is to create a low resistance pathway for aqueous outflow. The result is a blister or 'bleb' on the conjunctiva, from which fluid drains into the vasculature. Filtering surgery results may be compromised if blebs develop leaks, a problem that surfaces more frequently when antimetabolites are used to control the wound healing response. We investigated the role of tissue remodelling enzymes of the Matrix metalloproteinase (MMP) family in the development of bleb leaks. Our design was a case series. We enrolled glaucoma patients with leaking blebs, glaucoma patients with overhanging blebs and normal eyes. Leaking bleb tissues (n = 11) and bleb leak fluid were collected from patients undergoing bleb revision surgery. Overhanging bleb tissues (from non-leaking blebs, n = 3), normal conjunctiva (n = 8), and aqueous humour (n = 4) were collected for comparison. Samples were analysed for MMP content and proteinase activity by the methods of zymography, westernblotting, immunohistochemistry, and in situ zymography. Our main outcome measures were presence and activity of MMP in sample.Zymography revealed the presence of a high molecular weight caseinase and a 92-kDa gelatinase of a size appropriate for the proenzyme form of gelatinase B (gelB; MMP-9), in extracts from leaking bleb tissue, but not in bleb leak fluid or aqueous humour samples. In contrast, a 65-kDa gelatinase of a size appropriate for gelatinase A (MMP-2) proenzyme was observed in all samples. All proteinases disappeared when 10 mM EDTA was added to the development buffer, consistent with their identity as MMPs. Western blotting and immunohistochemical analyses confirmed the identity of the 92 kDa proteinase as gelB, and further revealed its absence from extracts of overhanging bleb tissue and normal conjunctiva. In situ zymography demonstrated strong gelatinolytic activity in leaking bleb tissue, but not overhanging bleb tissue or normal conjunctiva.

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Late Fistulization of Operative Wounds

Cited by 24 publications

References 1 publication

Conjunctival Advancement for Late-Onset Filtering Bleb Leaks

Conjunctival Advancement for Late-Onset Filtering Bleb Leaks

Effect of Excision of Avascular Bleb and Advancement of Adjacent Conjunctiva for Treatment of Hypotony

Matrix metalloproteinase gelatinase B (MMP-9) is associated with leaking glaucoma filtering blebs

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