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Abstract #96303 Published in IGR 22-3
Long-term outcomes of blebs repaired with scleral patch graft and conjunctival advancement in late-onset leak post-trabeculectomy
Pathak Ray V; Badakere SVIndian Journal of Ophthalmology 2021; 69: 2496-2501
PURPOSE: To report long-term outcomes in eyes that developed late-onset bleb leak post trabeculectomy, with or without hypotony and/or maculopathy, due to a scleral melt/fistula and who required a scleral patch graft and conjunctival advancement for repair. METHODS: Retrospective, non-comparative, interventional case series over a decade (2010-2019), presenting with late bleb leak post-filtration-surgery. All cases required a scleral patch graft and conjunctival advancement for management via a standard technique, performed by an experienced glaucoma surgeon. RESULTS: A total of 18 eyes were included. Mean age was 51.5 ± 10.2 years (95% CI [46.4-56.7]) and were followed up after repair for 52.4 ± 26.9 months, 95%CI [39.1-65.8]. 66.7% eyes (n = 12) had IOP ≦6 mmHg and also had hypotony maculopathy. None of the eyes presented with blebitis. 44.5% (n = 8) eyes underwent phacoemulsification as significant cataract was present. LogMAR best-corrected visual acuity (BCVA) was 0.8 ± 0.7 (95% CI [0.4-1.1]) prior to intervention and improved to 0.4 ± 0.6 (95% CI[0.1-0.6], P = 0.004). 22.3% (n = 4) eyes had persistent choroidal folds but BCVA was improved. Mean pre-intervention intraocular pressure (IOP) was 6.3 ± 3.8 mmHg (95% CI 4.4-8.2]) which increased to 12.1 ± 2.9 mmHg (95%CI[10.6-13.5], (P < 0.001). 27.8% (n = 5) eyes needed laser suture lysis post repair to control IOP; two needed further surgical intervention. Number of anti-glaucoma medications at last follow-up was 0.4 ± 0.9 (95% CI [-0.1-0.8], P = 0.09). No serious complications were encountered. CONCLUSION: Scleral patch graft and conjunctival advancement is a useful technique for repair of a scleral fistula post-filtering surgery, and this is recommended not only for the restoration of anatomy for prevention of infection and control of IOP, but also for visual rehabilitation.
Department of Glaucoma, Centre for Sight, Hyderabad, Telangana, India.
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