title: Algorithm approach for revision surgery following late-onset bleb complications after trabeculectomy: long-term follow-up.
abstract: The aim of this study was to introduce a reproducible algorithm for the surgical management of late-onset (>2 months) bleb complications after trabeculectomy with mitomycin C.
  We performed a retrospective review of eyes treated using a reproducible algorithm approach by a single surgeon for the surgical management of late-onset bleb complications from July 2006 to April 2014. Exclusion criteria were bleb revision with less than 3 months of follow-up or bleb revision combined with other glaucoma procedures at the time of surgery. Success was evaluated using the Kaplan-Meier survival method and defined as achieving all of the following criteria: primary surgery indication resolved, no additional surgery required for decreasing the intraocular pressure (IOP), and IOP of ≥6 mmHg and ≤18 mmHg.
  Twenty-three eyes from 20 patients were evaluated. Indications for bleb revision were hypotonic maculopathy (47.8%), bleb leak (30.4%), and dysesthetic bleb (21.7%). The overall primary outcome success rate calculated using the Kaplan-Meier survival method was 65.2% at 48 months. When the IOP target was changed to ≤15 mmHg, the bleb survival rate was 47.8% at 48 months. At the most recent postoperative visit, 95.7% of eyes had an IOP of ≤15 mmHg and 56.5% were being treated with an average of one medication per eye. One eye (4.3%) required a second bleb revision for persistent hypotony and two eyes required glaucoma surgery to reduce IOP during follow-up.
  An algorithm approach for the surgical management of late-onset bleb complications with a success rate similar to those reported in specialized literature is proposed. Randomized trials are needed to confirm the best surgical approach.
authors.affiliation: Fundación Oftalmológica los Andes, Vitacura, Santiago de Chile.
authors.forename: Claudio I
authors.initials: CI
authors.lastname: Perez
authors.affiliation: Fundación Oftalmológica los Andes, Vitacura, Santiago de Chile.
authors.forename: María J
authors.initials: MJ
authors.lastname: Oportus
authors.affiliation: Fundación Oftalmológica los Andes, Vitacura, Santiago de Chile.
authors.forename: Felipe
authors.initials: F
authors.lastname: Mellado
authors.affiliation: Fundación Oftalmológica los Andes, Vitacura, Santiago de Chile.
authors.forename: Felipe
authors.initials: F
authors.lastname: Valenzuela
authors.affiliation: Fundación Oftalmológica los Andes, Vitacura, Santiago de Chile.
authors.forename: Cristián
authors.initials: C
authors.lastname: Cartes
authors.affiliation: Fundación Oftalmológica los Andes, Vitacura, Santiago de Chile.
authors.forename: Daniela
authors.initials: D
authors.lastname: López-Ponce
authors.affiliation: Fundación Oftalmológica los Andes, Vitacura, Santiago de Chile.
authors.forename: Daniela
authors.initials: D
authors.lastname: Salinas-Toro
authors.affiliation: Program of Cellular and Molecular Biology, Faculty of Medicine-ICBM, University of Chile, Santiago, Chile.
authors.forename: Remigio
authors.initials: R
authors.lastname: López-Solís
authors.affiliation: Fundación Oftalmológica los Andes, Vitacura, Santiago de Chile.
authors.forename: Leonidas
authors.initials: L
authors.lastname: Traipe
mesh_terms: D000465:Algorithms; D001768:Blister / Q000209:etiology / Q000601:surgery*; D003432:Cross-Linking Reagents / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use; D015814:Ocular Hypotension / Q000209:etiology / Q000601:surgery; D011183:Postoperative Complications / Q000188:drug therapy / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D014130:Trabeculectomy / Q000009:adverse effects*
chemical_list: D003432:Cross-Linking Reagents; D016685:Mitomycin