Posterior Revision for Failed Blebs: Long-term Outcomes

AimTo report the long-term efficacy and safety of same site revision trabeculectomy with mitomycin application via a posterior approach. MethodsA noncomparative retrospective case series of consecutive revision trabeculectomies performed for inadequate bleb function between March 2003 and March 2007 by a single surgeon. Surgery involved a posterior/fornix incision with opening of the scleral flap posteriorly at the same site as previous surgery and application of 0.2 to 0.4 mg/mL mitomycin. ResultsFifty-seven eyes were followed for an average of 33±15 months. Mean baseline intraocular pressure (IOP) reduced from 21.5±6.5 to 11.2±4.4 and 8±3.6 mm Hg at 1 and 5 years, respectively (P<0.001). On Kaplan-Meier survival analysis the probability of maintaining IOP ⩽15 mm Hg without medication at the end of 1 year was 95% (n=57) and at 3 (n=36) and 5 years (n=7) was 84%. Eighty-five percent of patients were on no antiglaucoma drops at last follow-up. Four cases required a second procedure (7%), transient choroidal effusions occurred in 4 eyes (7%), corneal decompensation in 1 eye (1.7%), and ptosis in 1 (1.7%). ConclusionsPosterior approach to surgical revision of failed filtration surgery is an effective procedure with good long-term control of IOP.