Transconjunctival Revision With Mitomycin-C Following Failed Trabeculectomy

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Surgical Innovation

Background:

• Trabeculectomy is a common glaucoma surgery, but failure can necessitate further intervention.
• Failed trabeculectomy leads to elevated intraocular pressure (IOP) and potential vision loss.
• Revision surgeries aim to restore IOP control after initial surgical failure.

Purpose of the Study:

• To evaluate the efficacy of transconjunctival revision (TCR) with mitomycin-C (MMC) in patients with previously failed trabeculectomy.
• To assess visual acuity, IOP, and medication requirements post-TCR.
• To determine the success rates and complications associated with TCR and MMC.

Main Methods:

• Retrospective review of 27 patients (27 eyes) who underwent TCR with subconjunctival MMC.
• Standardized surgical protocol using a microvitreoretinal blade for conjunctival incision.
• Failure defined by IOP outside target range, vision loss, or need for further surgery.

Main Results:

• Mean preoperative IOP was 21.9 mmHg, reduced to 9.7 mmHg in successful cases.
• Success criteria met by 55.6% of patients; 1-, 2-, and 3-year success rates were 62%, 58%, and 53%.
• Complications included choroidal effusion, shallow anterior chamber, and corneal epitheliopathy.

Conclusions:

• Transconjunctival revision with mitomycin-C is a safe and effective option for managing failed trabeculectomy.
• Achieving long-term IOP reduction may require more than one revision procedure.
• TCR offers a viable alternative to repeat trabeculectomy with a manageable complication profile.