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Posterior revision of failed trabeculectomy may achieve strong IOP control
J Glaucoma. 2011;20(6):377-382.
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A posterior approach to surgical revision of failed trabeculectomy may effectively control IOP long-term, a study found.
"It is our view that the higher level of subconjunctival resistance contributes to the low levels of hypotonous complications, and full thickness nature of the flap and sclerostomy contributes to the low IOP. We believe, compared with previous techniques described for bleb revision, this technique offers higher long-term success rates with few complications," the study authors wrote.
Fifty-seven eyes of 52 patients had a mean follow-up of 33 ± 15 months in a noncomparative, retrospective case series. Surgery entailed a posterior/fornix incision to open the scleral flap at the site of previous surgery, as well as application of mitomycin C.
Mean baseline IOP decreased from 21.5 ± 6.5 mm Hg to 11.2 ± 4.4 mm Hg at 1 year and 8 ± 3.6 mm Hg at 5 years. According to Kaplan-Meier survival analysis, the probability of maintaining an IOP of 15 mm Hg or less without medication was 95% at 1 year and 84% at 3 and 5 years.
Four cases required a second procedure, and four eyes experienced transient choroidal effusions. Corneal decompensation and ptosis were observed in one eye each.