Risk Factors for a Severe Bleb Leak Following Trabeculectomy: A Retrospective Case-Control Study.

PURPOSE: To describe the population at risk of having a severe bleb leak needing a surgical repair in the operating room and to study risk factors associated with severe bleb leak. PATIENTS AND METHODS: In this case-control study, 17 cases were enrolled and paired with 51 controls. We studied all patients having a surgical revision in our center for a severe bleb leak between January 1 and December 31, 2008. Three controls were paired to each case based on their surgery date. We then analyzed risk factors related to the patient, the intervention, and the postoperative follow-up. RESULTS: Younger age was the only statistically significant risk factor for a severe bleb leak in our study. The odds of a severe bleb leak decreased as the age increased (P=0.0029). In comparing the risk for a severe bleb leak in younger (below 55 y) versus patients aged 75 years or older, the odds ratio was 21.0. There were no statistically significant differences between cases and controls with respect to: type of glaucoma, number or types of previous ocular surgeries, number of preoperative topical medications, localization of the leak, localization of the wound (fornix or limbus-based), or the intraocular pressure on day 1 postoperative. CONCLUSIONS: Younger age at the time of trabeculectomy may be a risk factor for severe bleb leak. A trend was observed in which the patients under the age of 55 years were at greater risk for a severe bleb leak.

Transconjunctival suturing of the scleral flap for overfiltration with hypotony maculopathy after trabeculectomy.

OBJECTIVE: To assess the efficacy of transconjunctival suturing of the scleral flap in improving hypotony maculopathy resulting from overfiltration after trabeculectomy. DESIGN: Retrospective review. PARTICIPANTS: 35 eyes of 33 patients. METHODS: Patients underwent transconjunctival scleral flap suturing for hypotony maculopathy following trabeculectomy using mitomycin C. The scleral flap was sutured through the conjunctiva as an outpatient clinic procedure using a spatulated needle with a 10-0 nylon suture. RESULTS: The average age of the patients was 67.5 (SD 4.80, range 39-83) years, and 52% patients were male. The average duration of hypotony prior to transconjunctival suturing of the flap was 108.0 (SD 68.3) days. The median intraocular pressure (IOP) before suturing was 3 mm Hg, and the median IOP 6 months after the procedure was 9 mm Hg (p < 0.0001). The median best-corrected visual acuity (BCVA) before transconjunctival suturing of the scleral flap was 20/100, and the median BCVA 6 months after the procedure was 20/30 (p < 0.0001). Compared with visual acuity before suturing the average gain in BCVA was 4.9 (SD 0.8) lines. CONCLUSIONS: Transconjunctival suturing of the trabeculectomy scleral flap is an effective treatment to raise IOP and improve visual loss from hypotony maculopathy after trabeculectomy with overfiltering blebs.