Purpose:
To evaluate the techniques and the results of revision surgeries in order to manage bleb failure after trabeculectomy.
Material and Method:
The records of 23 eyes who had undergone bleb revision surgery because of bleb failure after trabeculectomy between December 2002 and September 2009 were analyzed retrospectively. The mean age of the patients was 53.7±24.5 years. The mean intraocular pressure (IOP) before revision surgery was 32,4 ± 8,1 mmHg. Seven cases had needling, 7 had bleb revision surgery, 8 had repeat trabeculectomy, and 1 had scleral suture removal.
Results:
Sixteen cases were successfully treated, while 2 cases had this success with medication and 7 were unsuccessful with revision surgeries. The decrease in the IOP values was statistically significant in all visits after the surgeries (p<0.05). Four of 7 needling cases were successfully treated and 3 were unsuccessful. Four of 7 cases which had undergone bleb revision surgery were successful, whereas 3 were unsuccessful. Seven of 8 cases which had undergone repeat trabeculectomy were successful and 1 was unsuccessful. One case got the target IOP with antiglaucomatous medication after scleral suture removal.
Discussion:
Despite the high success rates of trabeculectomy performed to decrease IOP which is the main risk factor in glaucoma, it is possible to get unsuccessful results because of the early or late bleb failure. Several revision surgery techniques were defined to manage these situations. The success rates of these techniques were not as high as the primary surgeries, but they can maintain structural and functional improvement. However, large series especially comparing the success rates of surgical techniques are needed. (Turk J Ophthalmol 2012; 42: 207-10)
Keywords: Glaucoma, trabeculectomy, target intraocular pressure, bleb failure