Background: Trabeculectomy does not always work as long as necessary to control glaucoma. This study aimed to describe the initial outcomes of a surgical technique for restoring failed trabeculectomies. Methods: We reviewed patients with failed trabeculectomy with mitomycin (MMC) who underwent limbus-based revision. After the dissection of the subconjunctival area through a smaller incision (3 mm), MMC was applied and episcleral fibrosis was excised. Each criterion was classified as complete or qualified for glaucoma medication. Results: Nineteen patients (19 eyes) were included in this study. The mean follow-up was 9.4 ± 8.6 months. At the last follow-up visit, the mean intraocular pressure was reduced from 20.9 ± 8.4 (range, 12 - 44 mmHg) to 11.6 ± 3.6 mm Hg (range, 6 - 19 mmHg) (p < 0.01). The mean number of glaucoma medications was reduced from 2.6 ± 0.8 to 0.4 ± 0.7 during the same period (p < 0.01). At 6 months postoperatively, the qualified success rate was 68% and 85% for stricter and less strict criteria, respectively. Two cases of transient leakage and reoperation were required in three eyes. No sight-threatening complications were noted. Conclusions: Our initial results suggest that limbus-based revision is an effective alternative to restoring failed trabeculectomies with minor postoperative complications.
References
[1]
Weinreb, R.N. and Khaw, P.T. (2004) Primary Open-Angle Glaucoma. The Lancet, 363, 1711-1720. https://doi.org/10.1016/S0140-6736(04)16257-0
[2]
Collaborative Normal-Tension Glaucoma Study Group (1998) Comparison of Glaucomatous Progression between Untreated Patients with Normal-Tension Glaucoma and Patients with Therapeutically Reduced Intraocular Pressures. Collaborative Normal-Tension Glaucoma Study Group. American Journal of Ophthalmology, 126, 487-497. https://doi.org/10.1016/S0002-9394(98)00223-2
[3]
Heijl, A., Leske, M.C., Bengtsson, B., et al. (2002) Reduction of Intraocular Pressure and Glaucoma Progression: Results from the Early Manifest Glaucoma Trial. Archives of Ophthalmology, 120, 1268-1279. https://doi.org/10.1001/archopht.120.10.1268
[4]
Boland, M.V., Ervin, A.M., Friedman, D.S., et al. (2013) Comparative Effectiveness of Treatments for Open-Angle Glaucoma: A Systematic Review for the US Preventive Services Task Force. Annals of Internal Medicine, 158, 271-279. https://doi.org/10.7326/0003-4819-158-4-201302190-00008
[5]
Weinreb, R.N., Aung, T. and Medeiros, F.A. (2014) The Pathophysiology and Treatment of Glaucoma: A Review. The Journal of the American Medical Association, 311, 1901-1911. https://doi.org/10.1001/jama.2014.3192
[6]
Eyawo, O., Nachega, J., Lefebvre, P., Meyer, D., Rachlis, B., Lee, C.W., et al. (2009) Efficacy and Safety of Prostaglandin Analogues in Patients with Predominantly Primary Open-Angle Glaucoma or Ocular Hypertension: A Meta-Analysis. Clinical Ophthalmology, 3, 447-456. https://doi.org/10.2147/OPTH.S6501
[7]
Javitt, J.C. and Schiffman, R.M. (2000) Clinical Success and Quality of Life with Brimonidine 0.2% or Timolol 0.5% Used Twice Daily in Glaucoma or Ocular T Hypertension: A Randomized Clinical Trial. Brimonidine Outcomes Study Group I. Journal of Glaucoma, 9, 224-234. https://doi.org/10.1097/00061198-200006000-00005
[8]
Odberg, T. and Sandvik, L. (1999) The Medium and Long-Term Efficacy of Primary Argon Laser Trabeculoplasty in Avoiding Topical Medication in Open Angle Glaucoma. Acta Ophthalmologica Scandinavica, 77, 176-181. https://doi.org/10.1034/j.1600-0420.1999.770212.x
[9]
Rolim, D.M.C., Paranhos, A.J. and Wormald, R. (2007) Laser Trabeculoplasty for Open Angle Glaucoma. Cochrane Database of Systematic Reviews, 4, D3919.
[10]
Bloom, P.A. and Dharmaraj, S. (2006) Endoscopic and Transscleral Cyclophotocoagulation. British Journal of Ophthalmology, 90, 666-668. https://doi.org/10.1136/bjo.2005.082073
[11]
Cairns, D. (1968) Trabeculectomy: A Preliminary Report of a New Method. American Journal of Ophthalmology, 66, 673-679. https://doi.org/10.1016/0002-9394(68)91288-9
[12]
Roy, S., Ravinet, E. and Mermoud, A. (2001) Baerveldt Implant in Refractory Glaucoma: Long-Term Results and Factors Influencing Outcomes. International Ophthalmology, 24, 93-100. https://doi.org/10.1023/A:1016335313035
[13]
Cankaya, A.B. and Elgin, U. (2011) Comparison of the Outcome of Repeat Trabeculectomy with Adjunctive Mitomycin C and Initial Trabeculectomy. Korean Journal of Ophthalmology, 25, 401-408. https://doi.org/10.3341/kjo.2011.25.6.401
[14]
How, A., Chua, J.L.L., Charlton, A., et al. (2010) Combined Treatment with Bevacizumab and 5-Fluorouracil Attenuates the Postoperative Scarring Response after Experimental Glaucoma Filtration. Investigative Ophthalmology & Visual Science, 51, 928-932. https://doi.org/10.1167/iovs.09-3949
[15]
Li, Z., Van Bergen, T., Van de Veire, S., et al. (2009) Inhibition of Vascular Endothelial Growth Factor Reduces Scar Formation after Glaucoma Filtration Surgery. Investigative Ophthalmology & Visual Science, 50, 5217-5225. https://doi.org/10.1167/iovs.08-2662
[16]
Chen, T.C., Wilensky, J.T. and Viana, M.A. (1997) Long-Term Follow-Up of Initially Successful Trabeculectomy. Ophthalmology, 104, 1120. https://doi.org/10.1016/S0161-6420(97)30174-2
[17]
Fontana, H., Nouri-Mahdoavi, K., Lumba, J., Ralli, M. and Caprioli, J. (2006) Trabeculectomy with Mitomycin C: Outcomes and Risk Factors for Failure in Phakic Open-Angle Glaucoma. Ophthalmology, 113, 930-936. https://doi.org/10.1016/j.ophtha.2006.01.062
[18]
Gedde, S.J., Schiffman, J.C., Feuer, W.J., Herndon, L.W, Brandt, J.D. and Budenz, D.L. (2012) Treatment Outcomes in the Tube versus Trabeculectomy (TVT) Study after Five Years of Follow Up. American Journal of Ophthalmology, 153, 789-803.e2. https://doi.org/10.1016/j.ajo.2011.10.026
[19]
Meyer, L.M., Graf, N.E., Philipp, S., Fischer, M.T., Haller, K., Distelmaier, P., et al. (2015) Two-Year Outcome of Repeat Trabeculectomy with Mitomycin C in Primary Open-Angle and PEX Glaucoma. European Journal of Ophthalmology, 25, 185-191. https://doi.org/10.5301/ejo.5000542
[20]
Maestrini, H.A., Cronemberger, S., Matoso, H.D., Reis, J.R., Mérula, R.V., Filho, A.D., et al. (2011) Late Needling of Flat Filtering Blebs with Adjunctive Mitomycin C: Efficacy and Safety for the Corneal Endothelium. Ophthalmology, 118, 755-762. https://doi.org/10.1016/j.ophtha.2010.08.020
[21]
Feldman, R.M. and Tabet, R.R. (2008) Needle Revision of Filtering Blebs. Journal of Glaucoma, 17, 594-600. https://doi.org/10.1097/IJG.0b013e318181283e
[22]
Djafari, F., Lesk, M.R., Harasymowycz, P.J., Desjardins, D. and Lachaine, J. (2009) Determinants of Adherence to Glaucoma Medical Therapy in a Long-Term Patient Population. Journal of Glaucoma, 18, 238-243. https://doi.org/10.1097/IJG.0b013e3181815421
[23]
Okeke, C.O., Quigley, H.A., Jampel, H.D., et al. (2009) Adherence with Topical Glaucoma Medication Monitored Electronically: The Travatan Dosing Aid Study. Ophthalmology, 116, 191-199. https://doi.org/10.1016/j.ophtha.2008.09.004
[24]
Webers, C.A., Beckers, H.J., Nuijts, R.M. and Schouten, J.S. (2008) Pharmacological Management of Primary Open-Angle Glaucoma: Second-line Options and Beyond. Drugs Aging, 25, 729-759. https://doi.org/10.2165/00002512-200825090-00002
[25]
Shetty, R.K., Wartluft, L. and Moster, M.R. (2005) Slit-Lamp Needle Revision of Failed Filtering Blebs Using High-Dose Mitomycin C. Journal of Glaucoma, 14, 52-56. https://doi.org/10.1097/01.ijg.0000146364.90506.7c
[26]
Broadway, D.C., Bloom, P.A., Bunce, C., Thiagarajan, M. and Khaw, P.T. (2004) Needle Revision of Failing and Failed Trabeculectomy Blebs with Adjunctive 5-Fluorouracil: Survival Analysis. Ophthalmology, 111, 665-673. https://doi.org/10.1016/j.ophtha.2003.07.009
[27]
Law, S.K., Shih, K., Tran, D.H., Coleman, A.L. and Caprioli, J. (2009) Long-Term Outcomes of Repeat vs. Initial Trabeculectomy in Open-Angle Glaucoma. American Journal of Ophthalmologyogy, 148, 685-695.e.1. https://doi.org/10.1016/j.ajo.2009.05.032