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Marcos Suehiro, Fabio Zantut, Syril Dorairaj, Flavio Lopes, Tiago S Prata; SURGICAL OUTCOMES OF A SMALL INCISION LIMBUS-BASED REVISION FOR FAILED TRABECULECTOMIES. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2718. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To report the initial outcomes of a small incision limbus-based surgical approach for restoring failed trabeculetomies.
Noncomparative, interventional case series in which all glaucoma patients with a failed trabeculectomy and uncontrolled intraocular pressure (IOP) undergoing limbus-based revision between January 2013 and December 2014 were enrolled. It consists of a 15 minutes procedure in which initially a large subconjunctival area around the failed bleb is treated with mitomycin-C trough a 3 mm incision. Then, the fibrotic tissue is excised (and the internal ostium reopened through needling whenever necessary), reestablishing the flow to this treated area. Preoperative and postoperative IOP, number of antiglaucoma medications, surgical complications, and any subsequent related events or procedures were recorded. Two criteria were defined for evaluation of postoperative success. Criterion 1 was defined as a IOP≥6 mmHg and ≤18 mmHg and criterion 2 as a IOP≥6 mmHg and ≤15 mmHg. Each criterion was classified as complete (without hypotensive medication) or qualified (with antihypertensive medication).
Nineteen patients (19 eyes) with a mean age of 56.7±13.4 years were included in the study. Mean follow-up was 9.4±8.6 months and mean IOP was reduced from 20.9±8.4 (range, 12 - 44 mm Hg) to 11.6±3.6 mm Hg (range, 6 - 19 mm Hg) at the last follow-up visit (P<0.0001). The mean number of antiglaucoma medications was reduced from 2.6±0.8 to 0.4±0.7 during the same period (P<0.0001). At six months postoperatively, success rates ranged between 70% (for the stricter criterion) and 85% (for the less strict criterion). There were two cases of transient leakage and needling was required in 3 eyes.
Our initial results suggest limbus based revision as an effective alternative for restoring failed trabeculetomies with minor postoperative complications.
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