Rescue of failed filtering blebs with ab interno trephination.
We evaluated the effectiveness of ab interno automated trephination as a technique for rescuing failed mature filtering blebs. A retrospective chart review of 40 failed blebs of 38 patients who had a posttrephination follow-up period of at least 3 months was done. With success defined as intraocular pressure (IOP) <21 mm Hg and at least a 20% reduction from baseline on the same or fewer number of pretrephination medications, 30/40 eyes (75%) fit these criteria over the entire course of follow-up. Among all 40 eyes, there was a significant reduction of IOP from pretrephination to 3 months (P<.001). The percentage of patients requiring 2 or more medications declined from 90% pretrephination to 21% at 3 months (P<.0001), and was stable thereafter. Some patients were able to eliminate all medications. Patients who did not meet the criteria of success regained successful IOP control with other modalities of management. Complications were few. We believe that ab interno trephination is an excellent option for rescuing selected failed filtering blebs.
Shihadeh
Wisam A
WA
Department of Ophthalmology, The New York Eye and Ear Infirmary, New York, New York 10003, USA.
Ritch
Robert
R
Liebmann
Jeffrey M
JM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001768:Blister / Q000601:surgery*; D005260:Female; D018463:Filtering Surgery / Q000379:methods*; D005901:Glaucoma / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D014792:Visual Acuity