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Bleb excision, conjunctival advancement effective for filter repair
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Bleb excision and conjunctival advancement can be used to repair leaking blebs in eyes that are hypotonous after trabeculectomy, a study found. The technique can resolve the leaks and hypotony, maintain IOP control and preserve vision, according to a group of surgeons at the Jules Stein Eye Center and elsewhere.
Dana Tannenbaum, MD, and colleagues retrospectively reviewed the medical records of all patients who underwent bleb excision and conjunctival advancement surgery for bleb leaks or hypotony between 1993 and 2002. Hypotony was defined as an IOP of less than 6 mm Hg associated with reduced vision. Patients with more than 6 months follow-up were included in the study.
The study defined complete success as the resolution of the leak or hypotony with maintenance of IOP between 6 mm Hg and 21 mm Hg without further glaucoma surgery or glaucoma medications.
Of the 49 eyes included in the study, 13 had overt bleb leaks and 27 had hypotony. Nineteen patients underwent resuturing of sclera and/or placement of a pericardial graft in addition to bleb excision and conjunctival advancement.
Mean preoperative IOP increased from 3.2 mm Hg to 13.8 mm Hg at last follow-up. Mean preop visual acuity improved from 0.6 logMAR to 0.3 logMAR at final follow up. A total of 33 eyes achieved at least qualified success.
No significant difference was seen in the rates of complete or qualified success between the group of patients that underwent bleb excision and conjunctival advancement alone vs. the group that also had resuturing of sclera and/or placement of a pericardial graft.
The study is published in the January issue of British Journal of Ophthalmology.