Clinical observation of thin-walled filtering bleb nexplasty

Abstract

Objective To investigate the clinical effect of performing preserved poor filtering blebs and transposing pedicle conjunctival flap technique on thin-walled filtering blebs after filtering operation for treatment of glaucoma. Methods The procedure of modified operation involved incising the conjunctiva surrounding the preserved poor filtering blebs, cotton piece of Mitomycin for injection were putted under conjunctival flap on the fornix, then performing preserved poor filtering blebs, cleaning out the scar, repairing the sclera leakage, the pedicle conjunctival-Tenon,s fascia flap superior or temporal to the thin-walled filtering bleb was relaxed to cover the preserved sclera flap, the anterior margin of the flap was sutured onto the peripheral corner. Results In the follow-up of 6 months-3 years the mean intraocular pressure of 40 eyes increased to postoperative (13.74±6.58)mmHg from preoperative (6.54±2.78)mmHg (1mmHg=0.133KPa) (t=3.15, P<0.01), 40 eyes maintained the filtering function and Seidel fluorescein test negative, macular edema in 5 eyes disappeared, infections of 2 eyes were controlled, the edge of conjunctival flap dehisced and be repaired again in one eye. The post-operative visual acuities were elevated in comparison with that before the operation (χ2=15.78, P<0.01). Conclusions The transposing pedicle conjunctival flap and performing preserved poor filtering blebs technique is an effective surgery for repair of thin-walled filtering blebs whose complication, such as hypotony, maculopathy, bleb leakage or endophthalmitis can be cured or prevented. Key words: Glaucoma; Filtering operation; Antimetabolites; Thin-walled filtering bleb; Rotational conjunctival flap