Conjunctival advancement for late-onset filtering bleb leaks: indications and outcomes

To determine the indications and outcome of conjunctival advancement surgery for late-onset filtering bleb leaks.

Retrospective medical record review of a consecutive case series of all patients who underwent conjunctival advancement surgery for persistent late-onset glaucoma filtering bleb leaks at a tertiary referral center between December 1, 1985, and April 30, 1997.

Indications for surgery, preoperative and postoperative intraocular pressure (IOP), visual acuity, status of bleb leak, and need for reinstitution of medical therapy or reoperation for glaucoma.

Twenty-six eyes of 26 patients were analyzed. Complications from bleb leaks that necessitated surgical intervention included chronic ocular hypotony (n = 21), decreased visual acuity (n = 9), bleb-related infection (n = 11), hypotony maculopathy (n = 4), corneal edema with folds (n = 7), choroidal effusion (n = 3), and persistent shallow anterior chamber (n = 3). The mean +/- SD preoperative IOP was 5.7 +/- 4.9 mm Hg (range, 0-16 mm Hg). After a follow-up of 19.6 +/- 22.6 months, the IOP was 14.2 +/- 4.1 mm Hg for patients taking 1.1 +/- 1.3 glaucoma medications (all data given as mean +/- SD). Twelve patients (46%) had early-onset bleb leaks after revision, of which 7 (27%) closed spontaneously and 5 (19%) required resuturing. Two patients (8%) had a persistent bleb leak throughout the follow-up period. Thirteen patients (50%) required reinstitution of medical therapy during the follow-up period, and 2 (8%) required a reoperation for glaucoma for uncontrolled IOP.

Conjunctival advancement is a successful procedure for closing late-onset filtering bleb leaks. Some patients require suturing in the early postoperative period, but most patients eventually obtain permanent closure of the leak. Patients should be counseled of the possibility of requiring medical or surgical intervention for IOP control after revision.