A New Method for Revision of Encapsulated Blebs after Trabeculectomy: Combination of Standard Bleb Needling with Transconjunctival Scleral Flap Sutures Prevents Early Postoperative Hypotony.
OBJECTIVE
A simple needling procedure is the standard method for restoring the function of an encapsulated bleb after trabeculectomy. However, postoperative hypotony represents a possible hazard. This study describes a new surgical approach for treating encapsulated blebs with reduced risk of early postoperative hypotony: bleb needling combined with transconjunctival sutures tightening the scleral flap directly.


METHODS
The study included two groups of 23 patients with failing bleb following trabeculectomy: "Group 1" underwent simple needling revision of the filtering bleb and served as a control group, while "Group 2" received needling revision with additional transconjunctival scleral flap sutures, if intraoperatively the intraocular pressure was estimated to be very low. Intraocular pressure (IOP), postoperative management and complications were analyzed over a follow-up period of 4 weeks postoperatively. Results were compared using t-test or Mann-Whitney U-tests.


RESULTS
Adverse effects occurred with a higher frequency after sole needling of the bleb (5 cases of choroidal effusion and 1 case of choroidal hemorrhage) than after the combined method with additional scleral sutures (1 case of choroidal effusion). The IOP on the first postoperative day was significantly lower in group 1, with 9.43 ± 9.01 mm Hg vs. 16.43 ± 8.35 mm Hg in group 2 (P = 0.01). Ten patients with ocular hypotony (IOD of 5 mmHg or lower) were found in group 1 and only two in group 2. One week and one month after surgery the intraocular pressure was similar in both groups (P>0.05).


CONCLUSIONS
This new needling technique with additional transconjunctival scleral flap sutures appears to reduce postoperative hypotony, and may thus protect from further complications, such as subchoroidal hemorrhage.
Department of Ophthalmology, University Medical Center, Johannes Gutenberg- University Mainz, Mainz, Germany.
Panagiotis
P
Laspas
Department of Ophthalmology, University Medical Center, Johannes Gutenberg- University Mainz, Mainz, Germany.
Philipp David
PD
Culmann
Department of Ophthalmology, University Medical Center, Johannes Gutenberg- University Mainz, Mainz, Germany.
Franz Hermann
FH
Grus
Department of Ophthalmology, University Medical Center, Johannes Gutenberg- University Mainz, Mainz, Germany.
Verena
V
Prokosch-Willing
Department of Ophthalmology, University Medical Center, Johannes Gutenberg- University Mainz, Mainz, Germany.
Alicia
A
Poplawksi
Department of Ophthalmology, University Medical Center, Johannes Gutenberg- University Mainz, Mainz, Germany.
Norbert
N
Pfeiffer
Department of Ophthalmology, University Medical Center, Johannes Gutenberg- University Mainz, Mainz, Germany.
Esther Maria
EM
Hoffmann
D000368:Aged; D001768:Blister / Q000503:physiopathology / Q000601:surgery; D003315:Cornea / Q000473:pathology / Q000601:surgery; D005260:Female; D005901:Glaucoma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D015814:Ocular Hypotension / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery*; D012590:Sclera / Q000503:physiopathology / Q000601:surgery; D013524:Surgical Flaps; D014130:Trabeculectomy / Q000009:adverse effects / Q000379:methods*