Efficacy of Ab Interno Revision for Trabeculectomy Bleb Failure Using a Minimally Invasive Approach: A Prospective...

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Surgical Innovation

Background:

• Trabeculectomy is a common glaucoma surgery, but bleb failure can lead to elevated intraocular pressure (IOP).
• Failed trabeculectomy blebs often require intervention to restore IOP control.
• Traditional bleb revision can involve conjunctival manipulation, potentially impacting future management.

Purpose of the Study:

• To evaluate the safety and efficacy of Ab-Interno Bleb Revision (AIBR) for treating failed trabeculectomy blebs.
• To assess the impact of AIBR on intraocular pressure (IOP) and medication requirements.
• To determine the success and complication rates of AIBR.

Main Methods:

• A case series of 23 glaucoma patients with failed trabeculectomy blebs underwent AIBR.
• Patients received subconjunctival Mitomycin C prior to the procedure.
• The AIBR was performed using the Grover and Fellman spatula, with follow-up for 1 year.
• Primary outcomes included IOP and medication usage; secondary outcomes were failure rate and complications.

Main Results:

• Mean IOP decreased significantly from 23.54±10.7 mmHg preoperatively to 15.7±6.9 mmHg at 1 year (P=0.009).
• Antiglaucoma medication use reduced from a mean of 3.99±0.65 to 1.26±1.2 (P<0.001).
• Overall success was achieved in 82.6% of eyes (complete success: 39.2%, qualified success: 43.4%), with no sight-threatening complications.

Conclusions:

• Ab-Interno Bleb Revision (AIBR) is a safe and effective minimally invasive treatment for failed trabeculectomy blebs.
• AIBR offers improved IOP control while preserving conjunctival tissue for future interventions.
• This technique presents a promising alternative for managing challenging cases of bleb failure.