results of post-trabeculectomy bleb revision using conjunctiva

purpose: to evaluate and compare the results of different surgical methods for post-trabeculectomy bleb revision at labbafinejad medical center, tehran-iran, from 1999 to 2003. methods: this study was conducted on all patients who underwent post-trabeculectomy bleb revision due to hypotony [intraocular pressure (iop) less than 6 mmhg] or bleb leakage. surgical methods were: conjunctival advancement, rotational conjunctival flap and free conjunctival graft. bleb revision was performed in the cases of bleb leakage if the bleb hole was greater than 1 mm or leakage could not be controlled within 1 to 2 weeks of conservative treatment. bleb revision was performed in eyes with hypotony in cases with cataract development or progression or hypotony maculopathy or iridocorneal adhesion. surgical success was defined as iop between 6-21 mmhg with a maximum of 2 topical antiglaucoma medications and discontinuation of leakage. results: twenty-seven eyes of 27 patients (17 male, 10 female) with mean age of 37.8±15.2 years (9-37 years) were studied. indication for surgery was bleb leakage in 22 cases (81.5%) and hypotonous maculopathy in 5 cases (18.5%). mean iop was 4.4±1.04 mmhg preoperatively and 13.00±1.29 mmhg postoperatively. (p< 0.001) mean visual acuity was 0.9 logmar (20/160) before surgery and reached 0.6 logmar (20/80) after bleb revision. (p<0.002) mean cup/disc ratio was 0.7 preoperatively which remained unchanged postoperatively. conjunctival advancement was performed in 18 cases (success rate = 72.2%), rotational conjunctival flap in 6 cases (success rate= 66.7%) and free conjunctival graft in 3 cases (success rate= 66.7%). (p=0.73) bleb revision was repeated in 2 cases due to continuous leakage. mitomycin-c (mmc) and 5-fluorouracil had been used during primary trabeculectomy in 62% and 7.6% of cases, respectively. in 19.6% of cases surgery was done without using antimetabolites and usage of antimetabolites was unknown in 11%. the average time between primary trabeculectomy and bleb leakage or hypotonia was 17 months in cases with prior use of mmc and 52 months in the cases with no antimetabolite usage. (p<0.05) conclusion: post-trabeculectomy bleb revision using conjunctiva seems to be a successful method for control of leakage and prevention of complications of hypotony.