title: Conservative treatment for late-onset bleb leaks after trabeculectomy with mitomycin C in patients with ocular surface disease.
abstract: BACKGROUND
  Sodium hyaluronate and autologous serum eye drops are used to treat ocular surface disease (OSD) and are reported to prevent and treat late-onset bleb leaks following trabeculectomy with mitomycin C. In this study, we evaluated the efficacy of a combination of sodium hyaluronate and autologous serum eye drops and treatment for obstructive meibomian gland dysfunction as a therapy for late-onset bleb leaks after trabeculectomy with mitomycin C.
  
  
  METHODS
  This was a retrospective, interventional, nonsimultaneous study of 12 subjects (12 eyes) of mean age of 64.3 ± 18.3 years with OSD and apparent late-onset bleb leaks following trabeculectomy with mitomycin C between 1998 and 2008. We compared patients diagnosed with leakages before July 2005, who had been treated with separate eye drop solutions containing 0.1% sodium hyaluronate, 50% autologous serum, and 0.3% ofloxacin (sodium hyaluronate and autologous serum group, n = 7), with patients diagnosed from August 2005 to December 2008, who were treated with a combination of eye drops (0.1% sodium hyaluronate, 50% autologous serum, and 0.08% levofloxacin hydrate) and eyelid massage and warm compresses for obstructive meibomian gland dysfunction (combination eye drop group, n = 5).
  
  
  RESULTS
  Leakage was resolved in one patient (14.3%) in the separately treated sodium hyaluronate and autologous serum eye drop group and in five patients (100%) in the combination eye drop group (P = 0.015). The period after resolution of leakage with conservative treatment was 23 months in the one eye in the sodium hyaluronate and autologous serum group and 36-61 (mean 52.4 ± 10.1) months in the five eyes in the combination eye drop group.
  
  
  CONCLUSIONS
  Late-onset bleb leaks following trabeculectomy with mitomycin C can be treated effectively using a combination of sodium hyaluronate and autologous serum eye drops, eyelid massage, and warm compresses. Furthermore, combining eye drops may improve patient adherence to the drug regimen by decreasing the frequency of administration.
authors.affiliation: The Marui Eye Clinic, Fukushima.
authors.forename: Hideto
authors.initials: H
authors.lastname: Sagara
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Iida
authors.forename: Kimimori
authors.initials: K
authors.lastname: Saito
authors.forename: Hiroki
authors.initials: H
authors.lastname: Noji
authors.forename: Masashi
authors.initials: M
authors.lastname: Ogasawara
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Oyamada