Korean J Ophthalmol.  2009 Dec;23(4):281-285. 10.3341/kjo.2009.23.4.281.

Effect of Excision of Avascular Bleb and Advancement of Adjacent Conjunctiva for Treatment of Hypotony

• Lee K
• Hyung S

• KMID: 754764
• DOI: http://doi.org/10.3341/kjo.2009.23.4.281

Abstract

PURPOSE
To evaluate the efficacy of excision of avascular bleb and advancement of adjacent conjunctiva (EBAC) for treatment of hypotony after trabeculectomy with mitomycin C (MMC).
METHODS
Fifteen patients (17 eyes) who received EBAC for correction of hypotony between September 1996 and October 2008 were reviewed retrospectively. The main outcomes were intraocular pressure (IOP) and postoperative complications.
RESULTS
Hypotony (IOP <6 mmHg) of eight eyes (47.1%, seven patients) was caused by bleb perforation. Of these, two eyes (two patients) had a history of trauma. Hypotony appeared at 33.9+/-30.8 months, and EBAC was performed at 48.2+/-35.3 months after trabeculectomy with MMC. The mean follow-up period was 38.3+/-29.8 months. The qualified success rate of EBAC was 100% at 51 months after EBAC, and the complete success rate of EBAC was 76.5% at six months and 70.6% at 51 months, as determined by Kaplan-Meier analysis. Post-EBAC complications included blepharoptosis in four eyes (23.5%) and bleb perforation in one (5.9%). The blepharoptosis resolved within one month after EBAC in two patients. However, in the other patients, mild blepharoptosis remained at 17 and 22 months postoperatively.
CONCLUSIONS
EBAC was found to be an effective method for treatment of hypotony after trabeculectomy with MMC, and postoperative blepharoptosis was a major complication.

Keyword

Bleb; Conjunctiva; Excision; Hypotony

MeSH Terms

Adolescent
Adult
Aged
Blister/etiology/*surgery
Conjunctiva/*surgery
Female
Follow-Up Studies
Glaucoma/surgery
Humans
Intraocular Pressure
Male
Middle Aged
Ocular Hypotension/etiology/physiopathology/*surgery
Postoperative Complications
Reoperation
Retrospective Studies
Trabeculectomy/adverse effects
Treatment Outcome
Young Adult

Figure

• 

  Fig. 1 Scatter plot of preoperative intraocular pressure (IOP) and IOP at final follow-up. Mean preoperative IOP was 2.8±2.1 mmHg and mean IOP at final follow-up was 12.2±3.2 mmHg. IOP was significantly higher at final follow-up (p<0.001, t-test). EBAC=excision of avascular bleb and advancement of adjacent conjunctiva.

• 

  Fig. 2 Scatter plot of preoperative visual acuity (VA) and VA at final follow-up. Mean preoperative VA (logMAR) was 1.02±1.04 and mean VA (logMAR) at final follow-up was 0.54±0.97. Differences were not significant (p=0.243, t-test). EBAC=excision of avascular bleb and advancement of adjacent conjunctiva.

• 

  Fig. 3 Kaplan-Meier analysis of success rate of excision of avascular bleb and advancement of adjacent conjunctiva. Criteria for complete success were intraocular pressure (IOP) ≥6 mmHg and ≤18 mmHg with the use of no glaucoma medications. Criteria for qualified success were the same as that for complete success but with use of glaucoma medication to control IOP.

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