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Bleb revision surgery after trabeculectomy adequately addresses bleb-related complications
Ophthalmology. 2009;doi:10.1016/j.ophtha.2009.04.003.
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More than half of glaucoma patients who had bleb revision surgery after trabeculectomy to repair hypotony without leak, bleb leak or bleb dysesthesia demonstrated successful results, a study found.
"Surgical bleb revision often provides successful resolution of bleb-related complications," the study authors said. "Most patients maintain IOP control without need for further IOP-lowering surgery."
In addition, when multivariate regression analysis was adjusted for age, gender and number of previous surgeries, glaucoma subsets other than primary open-angle glaucoma were "twice as likely to have failed bleb revision," researchers said.
The retrospective case series examined 177 eyes of 167 patients who had revision of trabeculectomy. Patients were divided into three groups: hypotony without leak, bleb leak or bleb dysesthesia.
The mean time between trabeculectomy and bleb revision was 3.5 years, and the mean follow-up time after revision was 2.8 years.
The researchers found that the overall success rate for patients with leak repair was 65%; patients with hypotony had a success rate of 63%; and patients with dysesthesia had a success rate of 57%. The overall cumulative success rate at 1 year was 80%, at 2 years was 75%, at 5 years was 50% and at 10 years was 41%.
IOP and visual acuity significantly improved in the hypotony and leak groups. Overall, 9% of patients required additional IOP-lowering surgery.