Surgical revision of dysfunctional filtration blebs with bleb preservation, sliding conjunctival flap and fibrin glue.
OBJECTIVE
The introduction of anti-metabolite regimens to glaucoma filtration surgery has improved post-operative intraocular pressure (IOP) control; however, it has also increased the frequency of dysfunctional blebs. In this study, we report a surgical technique for the repair of trabeculectomy blebs using bleb preservation, a sliding conjunctival flap, and fibrin glue.


METHODS
This study is a retrospective, non-comparative, consecutive case series involving 10 eye samples collected from 10 patients (6 M : 4 F) with one or a combination of bleb overfiltration, dysesthesia, thinning, leak, or blebitis, in which a conjunctival flap was advanced over the failing bleb and secured in place using fibrin glue and sutures.


RESULTS
All patient eyes had symptom resolution post-operatively. There were no bleb leaks or hypotonous eyes after an average follow-up of 15.2 months (range: 6-31 months). Three patients required needling augmented with 5-fluorouracil needling to maintain IOP control. IOP decreased from a mean of 13.6+/-1.8 mm Hg (with a mean of 0.7 glaucoma medications) pre-operatively to 11.7+/-0.9 mm Hg (with a mean of 0.9 glaucoma medications).


CONCLUSIONS
Conjunctival flap advancement with bleb preservation and adjunctive fibrin glue is a successful technique used for the treatment of bleb dysfunction. The major advantages compared with other techniques are preservation of IOP control and reduced post-operative complications, such as wound leak and the need for re-suturing.
Lee
G A
GA
City Eye Centre, Department of Ophthalmology, Royal Brisbane and Women's Hospital, Department of Ophthalmology, University of Queensland, Brisbane, Queensland, Australia. eye@cityeye.com.au
Holcombe
D J
DJ
D000368:Aged; D003228:Conjunctiva / Q000601:surgery*; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D018463:Filtering Surgery / Q000379:methods*; D005901:Glaucoma / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D013524:Surgical Flaps; D014130:Trabeculectomy / Q000009:adverse effects
D015718:Fibrin Tissue Adhesive