Biplanar sclerostomy spatula used for ab interno bleb revisions

Researchers found that an ab interno translimbal bleb revision in eyes with a previously failed trabeculectomy can be safely performed with a biplanar sclerostomy spatula.

The retrospective chart review included 21 eyes of 21 patients who underwent the bleb revision with a Grover-Fellman biplanar sclerostomy spatula; all patients received mitomycin C at least 1 week before the operation. At 12 months’ follow-up, the average IOP was 12.1 mm Hg, decreased from 21.9 mm Hg at baseline, and 0.86 medications, down from 3.7.

Four eyes failed due to uncontrolled IOP and needed tube shunt placement. After 1 month, two eyes had an IOP of less than 5 mm Hg with no evidence of hypotony maculopathy, and the condition resolved after 3 months without surgery. The researchers said that the only other complications that occurred were four cases of IOP spikes.

“All successful cases had blebs that were low, diffuse and posterior. There were no cases of gross hyphema, flat anterior chambers or choroidal detachments,” the researchers wrote.

One drawback is that the revision is done in the operating room rather than at the slit lamp. However, the authors said, “[P]erforming this technique in the operating room allows one to selectively and predictably open the posterior flap, evaluate flow, break subconjunctival scarring in the far posterior fornix, and leave adequate Healon (to protect against immediate hypotony) in the eye in a more controlled, comfortable, safe and sterile environment.” – by Robert Linnehan

Disclosures: The researchers report no relevant financial disclosures.

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Source:

Grover DS, et al. J Glaucoma. 2017;doi:10.1097/IJG.0000000000000686.