Surgical repair of leaking filtering blebs

Purpose: To report the surgical management of leaking filtering blebs occur ring after blebitis or persistent hypotony. Design: Retrospective, noncomparative case series. Participants: Twenty-two eyes of 20 patients with late bleb leak, blebitis or endophthalmitis, hypotony maculopathy, or bleb dysesthesia on presentati on to the glaucoma service who required surgical bleb revision from 1990 th rough 1999. Intervention: Pedicle flap, partial excision, and advancement or free conju nctival autologous graft techniques for surgical bleb revision. Type of ble b revision was dependent on the dimensions of the bleb and quality. of surr ounding conjunctiva. Main Outcome Measurer Preoperative and postoperative intraocular pressure ( IOP), status of bleb leak, reoperation for glaucoma, or requirement for pos trevision glaucoma medical therapy, with success defined as the need for tw o or fewer glaucoma medications after revision. Results: Eighty-six percent (19/22) of eyes that underwent surgical bleb re vision had resolution of leak and IOP control using two or fewer medication s after one or more bleb revisions. The preoperative IOP (mean +/- standard deviation) was 3.7 +/- 2.6 mmHg (range, 0-8 mmHg). After an average follow -up of 21 months (range, 8-108 months), the IOP was 11.0 +/- 4.4 mmHg for p atients taking 0.6 +/- 1.0 glaucoma medications. Eighteen percent (4/22) of eyes required two or more bleb revisions. In one eye, an IOP spike of 36 m mHg developed after revision, which required laser suture lysis on two occa sions before the IOP was significantly lowered. The three failures were: on e eye that required three or more medications for IOP control, a patient wh ose eye had a persistent leak after revision and who was not mentally compe tent to undergo repeat revision, and one eye that required combined glaucom a and cataract surgery after revision. Conclusions: Surgical bleb revision has a high success rate of closing late bleb leaks, maintaining glaucoma control, and preserving vision, with few postoperative complications. The appropriate surgical procedure for revisio n must be based on the individual clinical situation and can result in succ essful bleb revision. Ophthalmology 2000;107:1681-1687 (C) 2000 by the Amer ican Academy of Ophthalmology.