Dintelmann T., Lieb W. E., Grehn F.

Universitätsaugenklinik Würzburg, Josef-Schneider-Str.11, D-97078 Würzburg

Objective: To report the surgical management and outcome of bleb-related complications, such is leaking filtering blebs, blebitis and overfiltration occurring after trabeculectomy, especially with use of adjunctive antimetabolites.
Methods: Retrospective analysis of 35 patients who underwent surgical repair of the filtering bleb in our hospital between 1991 and 2000. Reasons for revision were overfiltration with consecutive hypotony in 19 cases, chronic leakage in 11 cases, blebitis in 3 cases and exuberent blebs in 2 cases. The mean time from trabeculectomy to revision was 20,7 months (1d to 22a). Surgical techniques were 13x resuturing of the trabeculectomy flap, 7x bleb excision, 6x conjunctival suturing, 4x lyodurapatching, 4x autologous blood injection and 1x fibrin glue injection.
Results: In the eyes with leaking blebs mean preoperative intraocular pressure (IOP) was11,6±10,3 mmHg (range 0-40 mmHg). After an average follow-up of 12 months IOP was 11,9±3,3 mmHg (range 8-17 mmHg) without application of glaucoma medication. In 4 eyes a series of 5-FU injections and in one case needling of the bleb became necessary. In the eyes with overfiltration IOP was 2,4±1,5 mmHg (range 0-5 mmHg). After an average follow-up of 18 months IOP increased to 13,5±3,7 mmHg (range 5-19 mmHg) for patients taking 0,5±0,9 glaucoma medications. 4 eyes developed high IOP requiring additional surgery. Mean visual acuity improved by 3,6±5,9 lines postoperatively.
Conclusion: Surgical revision of leaking or overfiltrating blebs has a high success rate in regard to maintain a functioning filtering bleb and preserving vision. The appropriate surgical procedure must be adapted to the individual clinical situation.

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