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RJ Park, JM Liebmann, R Ritch; Ab Interno Automated Trephination for Failed Filtering Blebs . Invest. Ophthalmol. Vis. Sci. 2002;43(13):871.
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Purpose:To evaluate the effectiveness of ab interno bleb revision using an automated trephine in rescuing failed filtering blebs. Methods:We treated 21 failed blebs of 20 patients between 1995 and 2001. Blebs treated were previously functioning, mature, cystic, and well-defined. Patients were selected if they had previous trabeculectomy with or without anti-metabolites and a post-trephination follow-up period of at least 3 months. Results:Mean age was 68 ± 10.1 (SD) years (range 45-80). Mean follow-up time was 33.4 ± 23.0 months (range 3-108). Mean time between trabeculectomy and trephination was 53.1 ± 39.8 months (range 3-120). Sixteen eyes received anti-metabolites (5-FU) either at the time of trephination or post-operatively. View OriginalDownload SlideView OriginalDownload Slide Success was defined as IOP ≤21 mmHg with at least a 20% reduction from baseline on the same or fewer number of pre-trephination medications. Fifteen of 21 eyes (71%) met these criteria for success over the full course of follow-up. Of the 6 eyes which did not, 2 regained successful IOP control with the addition of one medication, 2 eyes regained successful control with a trans-conjunctival needle revision, 1 eye required no intervention, and 1 required a trabeculectomy revision. One eye developed a ciliary body detachment and hypotony, one developed cystoid macular edema, and one had a bleb leak and hypotony. All did well with conservative treatment. Conclusion:Bleb revision with ab interno trephination appears to hold promise as a tool for rescuing selected failed filtering blebs.
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