Augmentation of filtering blebs with perfluoropropane gas bubble: An experimental and pilot clinical study

Abstract

ObjectiveTo evaluate the use of perfluoropropane (C3F8) gas bubble in the augmentation of glaucoma-filtering blebs. DesignExperimental animal study and a pilot clinical study. ParticipantsTwenty rabbits in the animal study and 20 humans in the pilot study participated. InterventionTwenty patients underwent trabeculectomy for medically uncontrolled glaucoma. Surgical techniques were similar to those used in standard limbus-based trabeculectomies. The Tenon’s capsule and conjunctival wound were closed separately using continuous sutures. Before the final knots were tied, 0.1 to 0.2 ml of 15%:85%–C3F8:air mixture gas bubble was introduced into the subconjunctival space with a silicone tube attached to a 27-gauge Rycrof cannula. The sutures were immediately knotted on withdrawal of the tube. The patients were reviewed after surgery for the appearance, size, and location of the gas bubble. The bleb morphology and intraocular pressures were also monitored. Main outcome measuresThe parameters measured were intraocular pressure control, Snellen visual acuity, appearance of the bleb in relation to its elevation and degree of inflammation of the subconjunctival tissue, and characteristics of the gas bubble (e.g., size, number, and position). ResultsThe gas bubbles stayed in the conjunctival bleb for an average duration of 17 days (range, 13–27 days). In all cases, the gas bubbles helped to maintain the filtering bleb until their complete resolution. No excessive inflammation was noted in the filtering blebs. The mean preoperative intraocular pressure was 27.3 ± 5.5 millimeters of mercury (mmHg), and the mean postoperative intraocular pressure was 14.5 ± 2.3 mmHg, with only two patients requiring supplementary topical medication. All cases resulted in good filtering blebs with satisfactory intraocular pressures after 16 months of follow-up. ConclusionsSubconjunctival C3F8 gas bubbles, via a “spacer” effect, aid the maintenance of filtering blebs in the early postoperative period. This technique may be useful in augmenting or salvaging blebs at risk of failure.