Outcome of bleb revision using scleral patch graft and conjunctival advancement.
OBJECTIVE
To evaluate our surgical technique of bleb revision using scleral patch graft and conjunctival advancement, the long-term outcome and the ability to maintain adequate intraocular pressure (IOP) control.


METHODS
Retrospective review.


RESULTS
Eighteen patients were identified. The mean age was 72.1+/-4.3 years (95% confidence limits). In 12 of the 18 cases, the posterior edge of scleral patch graft was secured with fixed sutures, in another 3 with releasable sutures and in the remaining 3 with adjustable sutures. The mean follow-up period was 23.7+/-5.4 months (95% confidence limits). The mean preoperative IOP was 7.6+/-3.0 mm Hg (95% confidence limits), increased to 13.1+/-1.6 mm Hg (P=0.02) postoperatively. Twelve of the 18 patients had a minimum of 2-year follow-up. At this time point, 7 out of 12 (58%) patients had IOP <21 mm Hg without any medication, 9 out of 12 (75%) patients had IOP <21 mm Hg with medication, 7 out of 12 (58%) patients had IOP <16 mm Hg without medication, and 9 out of 12 (75%) had IOP <16 mm Hg with medication. The mean number of 5-fluorouracil injections with or without needling was significantly higher in the success group than in the failure group (P=0.035).


CONCLUSIONS
This series illustrates a useful technique using a scleral patch graft in cases of full-thickness scleral defect encountered during bleb revisions. The success rates achieved are comparable to those in the published literature, and furthermore our successful cases achieved lower IOPs appropriate for patients with advanced glaucoma.
Manchester Royal Eye Hospital, Manchester, UK.
Leon
L
Au
David
D
Wechsler
Fiona
F
Spencer
Cecilia
C
Fenerty
D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D003228:Conjunctiva / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D015812:Glaucoma, Angle-Closure / Q000601:surgery*; D005902:Glaucoma, Open-Angle / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D012590:Sclera / Q000637:transplantation*; D013524:Surgical Flaps; D013536:Suture Techniques; D014130:Trabeculectomy; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology
D000964:Antimetabolites, Antineoplastic