Posterior revision for failed blebs: long-term outcomes.
OBJECTIVE
To report the long-term efficacy and safety of same site revision trabeculectomy with mitomycin application via a posterior approach.


METHODS
A noncomparative retrospective case series of consecutive revision trabeculectomies performed for inadequate bleb function between March 2003 and March 2007 by a single surgeon. Surgery involved a posterior/fornix incision with opening of the scleral flap posteriorly at the same site as previous surgery and application of 0.2 to 0.4 mg/mL mitomycin.


RESULTS
Fifty-seven eyes were followed for an average of 33 ± 15 months. Mean baseline intraocular pressure (IOP) reduced from 21.5 ± 6.5 to 11.2 ± 4.4 and 8 ± 3.6 mm Hg at 1 and 5 years, respectively (P<0.001). On Kaplan-Meier survival analysis the probability of maintaining IOP ≤ 15 mm Hg without medication at the end of 1 year was 95% (n=57) and at 3 (n=36) and 5 years (n=7) was 84%. Eighty-five percent of patients were on no antiglaucoma drops at last follow-up. Four cases required a second procedure (7%), transient choroidal effusions occurred in 4 eyes (7%), corneal decompensation in 1 eye (1.7%), and ptosis in 1 (1.7%).


CONCLUSIONS
Posterior approach to surgical revision of failed filtration surgery is an effective procedure with good long-term control of IOP.
Coote
Michael A
MA
Centre for Eye Research Australia, University of Melbourne, Victoria, Australia. mcoote@bigpond.net.au
Gupta
Viney
V
Vasudevan
Sushil
S
Crowston
Jonathan G
JG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000477:Alkylating Agents / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D012086:Reoperation; D012189:Retrospective Studies; D012590:Sclera / Q000187:drug effects; D013524:Surgical Flaps; D013997:Time Factors; D014065:Tonometry, Ocular; D014130:Trabeculectomy; D017211:Treatment Failure; D016896:Treatment Outcome
D000477:Alkylating Agents; D016685:Mitomycin