A New Method for Revision of Encapsulated Blebs after Trabeculectomy: Combination of Standard Bleb Needling with Transconjunctival Scleral Flap Sutures Prevents Early Postoperative Hypotony

Abstract

PurposeA 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.MethodsThe 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.ResultsAdverse 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).ConclusionsThis 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.

Effectiveness and Safety of Trabeculectomy along with Amniotic Membrane Transplantation on Glaucoma: A Systematic Review

“…On the basis of review, the AMT group was able to avoid this complication, which may reduce the recurrence of glaucoma. Collagen-producing fibroblasts are always the reason for encapsulated blebs, which may elevate IOP, leading the eye to be uncomfortable from the effects of a localized dellen [ 36 ]. The AMT group had a lower prevalence of fibroblasts than the control group, though without significance.…”

Revision nach Filtrationschirurgie

“…Die Tenonzyste entwickelt sich zwi-Abb. 8 [24], können diese mit transkonjunktivalen Skleradeckelnähten kombiniert werden [13].…”

“…Der Operationserfolg von FilterkissenNeedling, Nadelrevision und offener Revision des Filterkissens kann durch eine Nachbehandlung mit Antimetaboliten verbessert werden [13,20,26]. Die Anzahl der postoperativen subkonjunktivalen 5-FU-Injektionen richtet sich dabei nach der Invasivität des Revisions- …”

Ab interno bleb needling revision: a new approach

“…Transconjunctival scleral flap sutures have been used in conjunction with bleb needling to avoid postoperative hypotony and may be useful if there is intraoperative overdrainage and anterior chamber collapse. 2 Needling ab interno can be utilized for routine bleb needling but is particularly useful if there is risk of significant conjunctival bleeding, poor access to the superior conjunctiva, and if there is thin or scarred tissues prone to buttonhole. It does need to be performed in the operating theater, where the anterior chamber can be controlled with continuous infusion, precise manipulation of the eye with the traction suture, and remedial measures undertaken if bleb perforation or overdrainage from the flap occurs intraoperatively.…”

“…Graham A Lee MD FRANZCO, 1,2,3 Desirée Murray FRCOphth 4 and Peter Shah FRCOphth 3,5,6 1 City Eye Centre, 2 The Lions Outback Vision Van was launched in March 2016 and is a mobile eye clinic providing ophthalmology care to regional and remote Western Australia. For the first time, we have been able to bring essential equipment to regional and remote towns to improve the delivery of our ophthalmology service (Figs 1, 2 We present two cases that highlight the benefits of this equipment during pre-operative assessment, which were previously unavailable at rural locations.…”