Expanded indications for transconjunctival trabeculectomy flap suturing: postoperative choroidal effusion and dysesthesia.

OBJECTIVE: To assess the efficacy of transconjunctival trabeculectomy flap suturing (TTFS) in improving choroidal effusions and bleb dysesthesia resulting from overfiltration after trabeculectomy. DESIGN: Retrospective review. PARTICIPANTS: The study involved 15 eyes of 15 patients. METHODS: Patients underwent TTFS for choroidal effusions and bleb dysesthesia following trabeculectomy using mitomycin C. The scleral flap was sutured through the conjunctiva as an outpatient clinic procedure. RESULTS: There were 11 patients who had choroidal effusions and 4 patients were identified with dysesthesia. The average duration of choroidal effusion prior to TTFS was 2.1 ± 2.3 months and 3 ± 2 months in the dysesthesia group. At the final follow-up (25 ± 17 months) the mean intraocular pressure improved from 4.1 ± 2.1 mm Hg before suturing to 8.1 ± 3.6 mm Hg (p < 0.007) for the patients with choroidal effusion and from 4.2 ± 0.6 mm Hg to 8. 7 ± 3.5 mm Hg (p = 0.05) for the patients with dysesthesia. In both groups, resolution of the signs and symptoms was achieved in all cases. The mean time to resolution of choroidal effusions was 5.5 ± 8.6 weeks and the mean time to resolution of dysesthesia was 2 ± 0.8 weeks. None of the patients had serious complications such as failure of the trabeculectomy or visual loss. CONCLUSIONS: Transconjunctival suturing of the trabeculectomy scleral flap is a simple and effective surgical method for the treatment of cases of choroidal effusions or dysesthesia resulting from trabeculectomy.

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.

Bleb needle redirection for the treatment of early postoperative trabeculectomy leaks: a novel approach.

BACKGROUND: This study describes a technique of bleb needling as a management of early postoperative limbal bleb leaks unresponsive to conservative management. This technique redirects the aqueous into a newly formed bleb, sealing the leak easily and rapidly. METHODS: Medical records of patients with early bleb leaks after trabeculectomy or phacotrabeculectomy between November 2004 and September 2005 were reviewed retrospectively. Patients whose bleb leaks were unresponsive to conservative management and who underwent needling procedures were identified and studied further. RESULTS: Six of 18 patients who had early bleb leaks did not respond to conservative treatment and underwent a needle redirection of their blebs, which sealed within a few days after needling. The mean follow-up time of this group was 6 months. The mean preoperative vision was 20/50 with a mean preoperative intraocular pressure (IOP) of 27 using 2.8 medications, and this improved postoperatively and postneedling to a vision of 20/30 with a mean IOP of 11 using 0.16 medications. INTERPRETATION: Bleb needling with subsequent redirection of aqueous into a new bleb should be considered as an option in the treatment of limbal leaks after a trabeculectomy that does not respond to conservative treatment.