Long-term Functional Outcomes of Trabeculectomy Revision Surgery

A Brief Review of Historical and Current Trends in Trabeculectomy

“…Several large retrospective studies have reported a range of 49% to 70% and 41% to 52% survival rate in IOP control after 5 and 10 years, respectively, following revision surgery. [35][36][37][38] Interestingly, several studies have noted that the survival rate of revision surgery was dependent on the indication for surgery, with higher success when it was due to bleb leaks and hypotony (57% to 65% and 60% to 63%, respectively) compared with uncontrolled IOP (44%). 35,39 Multiple studies have demonstrated improvements in visual outcome with bleb revision for hypotony maculopathy.…”

“…[35][36][37][38] Interestingly, several studies have noted that the survival rate of revision surgery was dependent on the indication for surgery, with higher success when it was due to bleb leaks and hypotony (57% to 65% and 60% to 63%, respectively) compared with uncontrolled IOP (44%). 35,39 Multiple studies have demonstrated improvements in visual outcome with bleb revision for hypotony maculopathy. 35,39,40 There is no standardized technique for approaching revision surgery, but the process usually involves mobilizing the conjunctiva, lysing the episcleral adhesions, and possibly suturing the scleral flap to adjust aqueous flow.…”

“…35,39 Multiple studies have demonstrated improvements in visual outcome with bleb revision for hypotony maculopathy. 35,39,40 There is no standardized technique for approaching revision surgery, but the process usually involves mobilizing the conjunctiva, lysing the episcleral adhesions, and possibly suturing the scleral flap to adjust aqueous flow. Perez et al 39 described a surgical algorithm for blebrelated complications based on assessment of conjunctival health and filtration at the scleral flap.…”

“…In cases of inadequate IOP control, incisional surgery at the existing scleral flap with adjunctive mitomycin C (MMC) can salvage the primary trabeculectomy and reestablish flow with reasonable long-term efficacy. Several large retrospective studies have reported a range of 49% to 70% and 41% to 52% survival rate in IOP control after 5 and 10 years, respectively, following revision surgery 35–38 …”

“…Chen and Moeller 36 demonstrated that a limbal-based incision of 4 to 8 mm in width to remove episcleral fibrosis and establish flow at the preexisting scleral flap had 70% success in IOP control and minimal medical therapy at 5 years. In patients with late-onset bleb leaks, conjunctival advancement with or without patch graft, re-suturing of the scleral flap, and choroidal drainage are surgical options for normalizing IOP and closing the leak 35,41,42 . However, conservative measures including autologous blood injection, lubrication and patching, bandage contact lens, and cyanoacrylate glue have been applied individually and in combination to treat bleb leaks 43 .…”