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Late hypotony secondary to dysfunctional bleb: clinical features and results of surgical repair

Session Details

Session Title: Glaucoma

Session Date/Time: Monday 07/10/2013 | 17:00-18:34

Paper Time: 17:34

Venue: Elicium 2 (First Floor)

First Author: : A.Dyrda SPAIN

Co Author(s): :    M. Pazos   A. Antón           

Abstract Details

Purpose:

To present a review of cases operated on late hypotony after filtration procedure in our hospital in the last four years and to analyse possible causes and surgical outcomes.

Setting:

Case series

Methods:

The retrospective review of clinical charts of patients who underwent surgical bleb reconstruction secondary to late hypotony at our ophthalmology department between January 2008 and December 2012 is presented. Patients included in the study met the definition of late hypotony as hypotension after at least 6 months of a glaucoma filtration procedure associated to compatible structural and/or functional ocular changes.

Results:

Six patients of age of 71.3 years were diagnosed 6.5 years (± 3) after primary filtration procedure. In three cases 0.02% MMC was used. Intraocular pressure (IOP) and visual acuity (VA) were 3 mmHg (± 2.2) and 0.2 respectively. Structural changes: macular folds (n = 3), papilledema (n = 2), corneal edema (n = 1) and choroid detachment (n = 1) were found. All patients presented dysfunctional bleb with avascular zone and associated leak and consecutive blebitis in 2 and 1 patient respectively. Surgical approach involved bleb excision with conjunctival advancement in all cases with re-suturing of scleral flap (n=1) or scleral patching (n=5). The mean IOP immediately after surgery was 17.7 ± 4 mmHg. We observed rapid resolution of the structural changes in all cases in the early postoperative period, but VA improved only in 3 cases (50%). After 17 months (4-50) of follow up the mean IOP and VA were 13.7mmHg (± 2.4) and 0.4 (± 0.1), respectively. We observed visual gain of 2 lines (±1) on average in all cases. The glaucoma progression using GPA was valued in patients with follow up of at least 6 months with only one case of visual field deterioration.

Conclusions:

Filtration procedures, especially with antimetabolites, may result in complications like late hypotony even years after surgery. Late hypotony is difficult to treat and often requires individualized surgical management based on reconstruction with excision of the bleb, conjunctival advancement and scleral patching to increase IOP. Despite very good anatomical results, functional results are not always as successful as mention in literature, but as our case-series showed good functional result are possible. The long-term monitoring of operated patients is crucial for detecting dysfunctional blebs that are more likely to develop this serious and fortunately uncommon complication.

Financial Interest:

NONE