Surgical Reduction of Symptomatic Filtering Blebs

Abstract

Abstract: : Purpose: To present two techniques for surgical reduction of dysesthetic filtering blebs formed after trabeculectomy with antifibrotic agents. Methods: Twenty one eyes of 20 patients underwent surgical bleb reduction. All patients had symptomatic, thin blebs overhanging the cornea or crescent–shaped circumferential blebs. Success was defined as subjective resolution of symptoms and maintenance of intraocular pressure (IOP) with no subsequent surgical intervention. In 15 eyes of 14 patients with circumferential blebs, a #75 blade was used to make an incision through the filtering bleb and carried down to the sclera to divide the bleb into an upper and a lower portion. Interrupted 9–0–vicryl sutures were used to reappose the incised edges of the conjunctiva and Tenon’s capsule to the sclera. In 6 patients with overhanging blebs, dissection of the corneal portion of the bleb was performed using a #69 blade. Excess bleb tissue was excised using Vannas scissors. Bandage contact lenses were placed post–operatively. Results: Mean age at revision was 69 ± 8.75 yrs (range 51–82 yrs). Mean time between trabeculectomy and revision was 3.8 ± 3.78 yrs (range 0.3–12 yrs). Average IOP pre–revision was 9.5 ± 5.0 mmHg and post–revision was 10.0 ± 5.1, p=0.75 at 1 month, 10.2 ± 5.0, p=0.68 at 3 months, and 10.1 ± 6.0, p= 0.76 at 1 year. In 18/21 eyes (85.71%), symptoms of dysesthesia disappeared and in 3/21 eyes (14.29%) some improvement was noticed. Two patients had bleb leaks, 1 of which resolved spontaneously and 1 of which required glue application. All patients maintained pre–revision visual acuity. There was no recurrence of bleb extension and no need for subsequent surgical intervention. Conclusions: Surgical reduction of overhanging or circumferential filtering blebs is a safe and effective technique in reducing bleb dysesthesia and improving cosmetic appearance without any loss of filtering function.

Keywords: conjunctiva • clinical (human) or epidemiologic studies: outcomes/complications