Revision of dysfunctional filtering blebs by conjunctival advancement withbleb preservation

PURPOSE: To assess the outcome of advancing a conjunctival nap with preserv ation of the bleb in eyes undergoing filtration bleb revision after trabecu lectomy, METHODS: A retrospective review of cases from a university-based referral p ractice identified 30 eyes of 30 patients that had undergone bleb revision after trabeculectomy by advancement of a conjunctival flap over the de-epit helialized bleb, Success was defined as resolution of the bleb-associated c omplication necessitating the revision (leak, hypotony, discomfort) with ma intenance of intraocular pressure greater than or equal to 6 and less than or equal to 21 mm Hg without glaucoma medications, Qualified success met th e above criteria but with the use of glaucoma medications, Summary data inc luding visual acuity were obtained. RESULTS: On the 30 eyes, 30 conjunctival advancement procedures were perfor med, Seventeen were for bleb leaks, 10 for prolonged hypotony without bleb leak, and three for dysesthetic bleb, Eighteen eyes (60%) were classified a s a complete success and 24 eyes (80%) achieved at least a qualified succes s, Cumulative probability of at least qualified success was 77% at 2 years, Failures included inadequate intraocular pressure control tone eye), recur rent bleb leak (three eyes), and hypotony without bleb leak (two eyes). The mean preoperative intraocular pressure for all eyes increased from 4.4 +/- 3.7 mm Hg to 12.3 +/- 6.2 mm Hg (P < .00001) at the final visit with a mea n follow-up of 18.9 +/- 15.5 months. Visual acuity improved or remained wit hin 1 line of preoperative acuity in all but five patients, Complications i ncluded two patients with mild ptosis and four patients with hypertropia. CONCLUSION: Advancement of a conjunctival flap with preservation the preexi sting bleb often provides successful resolution of bleb associated complica tions. (C) 2000 by Elsevier Science Inc. All rights reserved.