Excisional bleb revision to correct overfiltration or leakage

Objectives: To evaluate the effectiveness of excisional revision of filteri ng blebs for hypotony or leakage when more conservative measures have faile d. Patients and Methods: Retrospective review of all patients who underwent ex cisional revision of a filtering bleb for hypotony (intraocular pressure [I OP] <5 mm Hg) or leakage during a 3 year period. The revision consisted of excision of the avascular bleb, mobilization of the surrounding conjunctiva , and suturing of the conjunctiva at the limbus. Results: Sixteen patients were included in the study. The average age was 6 6.3 +/- 14.8 years (range, 39-83). Revision followed trabeculectomy in 11 c ases, combined phacoemulsification-trabeculectomy in three cases, and inadv ertent blebs in two cases. Five cases had bleb leaks without hypotony, four cases had hypotony alone, and seven cases had both hypotony and a bleb lea k. Average follow-up after bleb revision was 25 +/- 11 months (range, 9-43) . Average IOP increased from 3.8 +/- 5.6 mm Hg (range, 0-22) to 11.9 +/- 4. 1 mm Hg (range, 3-18), with an average of 1.1 +/- 1.1 medication (range, 0- 3). The IOP at the last visit was <15 mm Hg in all but two patients, with 1 0 of the 16 patients requiring medications. At the last follow-up examinati on, visual acuity had improved greater than or equal to two lines in nine p atients and was reduced two lines in one patient. Five patients had early p ostoperative limbal wound leaks; resuturing was required in one case. Conclusions: Excisional bleb revision is an effective technique to correct hypotony or leakage after filtering surgery when other methods have failed. Intraocular pressure control is often maintained with the use of medicatio ns.