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S. Radhakrishnan, H. Quigley, H. Jampel, D. Friedman, S. Ahmad, N. Congdon, S. McKinnon, D. Zack; Outcomes of Revision Surgery for Complications of Trabeculectomy. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4161.
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© ARVO (1962-2015); The Authors (2016-present)
To report the outcome of surgical revision for complications of trabeculectomy.
A retrospective, chart review of 162 patients (168 eyes) undergoing bleb revision by 6 glaucoma specialists at the Wilmer Eye Institute between 1994 and 2007 was performed. Three groups were divided by surgical indication: hypotony (50 eyes/47 patients), bleb leak (90 eyes/89 patients), and dysesthesia (27 eyes/25 patients). Over 3 months follow-up was required, unless early failure occurred. Revision surgery consisted of removal of excess, leaking or thin conjunctiva, conjunctival advancement or free graft, and resuturing of scleral flap and drainage of choroidal detachment (when indicated).
Complete success was obtained in over 60% of patients overall (hypotony, 62%; leak, 64%; dysesthesia, 54%) at mean follow-up of 2.8 + 2.7 years (Range 12 days - 10.5 years). After revision for hypotony, in which improving vision was primary, 76% (38 eyes) had better acuity at last follow-up (logMAR mean improvement = +0.30 + 0.31, P<0.0001, paired t test), representing improvement from 20/75 to 20/35 equivalent. Among all 3 groups, 19% had worse acuity, some unrelated to IOP or glaucoma status. Mean IOP increased significantly in both hypotony (from 3.6 + 2.6 to 11.5 + 9.6 mm Hg) and leak (from 6.7 + 4.7 to 12.8 + 5.5 mm Hg) groups (both P<0.0001) and was stable in the dysesthesia group (P = 0.15). Failure to achieve the main indication requiring a second attempt occurred in 22% (37 eyes) overall. An additional 9.5% (16 eyes) were deemed failures because of subsequent IOP-lowering surgery.
Despite reasonable success with trabeculectomy revision surgery, further improvements would be welcome.
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