Abstract
Purpose: To evaluate the causes of bleb failure or dysfunction after trabeculectomy and to assess the various medical and surgical therapeutic measures used for reviving a failing filtration bleb
Patients & Methods: All glaucoma patients who had undergone primary trabeculectomy within the period between November 2001 and October 2002 were followed up for a period of 36 months for the function of the filtering bleb and outcome of trabeculectomy. Several medical and surgical techniques have been employed to revive the failed blebs according to the cause of failure and other factors related to each patient.
Results: A consecutive 61 patients (68 eyes) who underwent primary trabeculectomy over a 12-month period were subjected to this study. Post-trabeculectomy, 21 eyes (30.8%) showed bleb failure or dysfunction; bleb encapsulation developed in 9 eyes (13.2%); bleb leak in 7 eyes (10.3%); overhanging blebs in 3 eyes (4.4%); and blebitis in 2 eyes (2.9%). The specific management of various types of bleb failure will be discussed in details in this paper.
Conclusion: More than ever, successful trabeculectomy requires careful preoperative planning, proper surgical technique, and close attention to the postoperative period. The first step of successful management of failing bleb is timely and accurate recognition of the problem, and once recognized, it should be treated properly in the early postoperative period.