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Related Experiment Videos

Conjunctival dysfunction and mitomycin C-induced hypotony.

R Sihota1, T Dada, S D Gupta

  • 1Glaucoma Service, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi.

Journal of Glaucoma
|October 20, 2000
PubMed
Summary
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A dysfunctional conjunctival barrier can cause chronic hypotony after mitomycin C-enhanced trabeculectomy. Surgical revision with a conjunctival graft safely restores intraocular pressure and improves vision.

Area of Science:

  • Ophthalmology
  • Glaucoma Surgery
  • Ocular Surface Disease

Background:

  • Mitomycin C-enhanced trabeculectomy is a common glaucoma surgery.
  • Chronic hypotony can occur post-trabeculectomy, leading to vision loss.
  • The role of the conjunctival bleb integrity in hypotony is not fully understood.

Purpose of the Study:

  • To investigate the role of a physically intact conjunctiva in chronic hypotony after mitomycin C-enhanced trabeculectomy.
  • To evaluate the efficacy of conjunctival flap revision for hypotony management.

Main Methods:

  • Evaluated three patients with hypotonic maculopathy post-mitomycin C trabeculectomy using Seidel testing and anterior segment fluorescein angiography.
  • Performed bleb excision and reconstruction with a pedicle conjunctival flap.

Related Experiment Videos

  • Conducted histopathologic examination of excised bleb tissue.

    • Main Results:

    • Negative Seidel tests masked generalized aqueous seepage from the bleb.
    • Bleb revision led to increased intraocular pressure, reversal of hypotonic maculopathy, and improved visual acuity in all patients.
    • Histopathology revealed alterations in the conjunctival epithelial basement membrane.

    Conclusions:

    • A dysfunctional conjunctival barrier (evidenced by bleb "sweating" and histopathology) may cause hypotony.
    • Conjunctival flap revision is a safe and effective treatment for chronic hypotony after mitomycin C-augmented trabeculectomy.