Evaluation of the outcome of ab-interno revision in high-risk failing trabeculectomy bleb

Abstract

Purpose The purpose of this study was to evaluate the outcome of ab-interno revision as a method to re-establish filtration in a failing trabeculectomy bleb.Patients and methods This is a retrospective clinical study that included 56 patients who underwent one or more revisions of a failing trabeculectomy bleb through the years 2014–2015. Once recognized, a failing bleb was treated aggressively using anti-inflammatory agent, antifibrotic agent, digital massage, and/or argon laser suture lysis. If those measures failed, the revision technique of the bleb was applied. A failing bleb is defined as intraocular pressure (IOP) greater than 21 mmHg combined with flat vascularized bleb.Results The mean age of the included cases was 56.18±10.88 years. Out of the 56 cases operated, 16 (28.57%) cases failed, 12 (21.42%) of whom had clinical failure and four (7.14%) had technical failure. Regarding the drop in IOP, for the complete success group, there was a marked significant drop of IOP shortly postoperatively and after 6 months.Conclusion Patients with failing filtration bleb because of different types of glaucoma benefit from 5-fluorouracil-augmented ab-interno revision to re-establish the full pathway from the anterior chamber to the subconjunctival space. However, the least response was noticed in the neovascular type of glaucoma.