PURPOSE: To understand risk factors for failure of glaucoma filtering surgery. PATIENTS: A retrospective study of 67 eyes (16 nonpenetrating trabeculectomies, 51 trabeculectomies [31 with 5FU and 20 with mitomycin]) of 61 patients in whom 5FU bleb revision was needed because of increasing intraocular pressure. Postoperative incidents were analyzed to explain excessive subconjunctival fibroblastic proliferation. RESULTS: In eight cases, IOP increased after 6.16 months (+/-2) and for 59 eyes, after 33.5 days after surgery (+/-11.4). Postoperative incidents were 24 (35.9%) bleb leaks, nine cases (13.4%) of hypotony with choroidal detachment, six (9.0%) iris incarcerations, seven (10.4%) cystic blebs, and 21 (31.3%) inflammatory flat blebs. After a mean follow-up of 27 months +/- 18, the success of bleb 5FU revision was 84.6% for nonpenetrating trabeculectomy (without glaucoma treatment, 69.2%; with medical treatment, 15.4%) and 73.9% for trabeculectomy (47.8% and 32.6%). CONCLUSION: Postoperative outcomes favor an inner or outer obstacle to conjunctival filtration. Aqueous humor can no longer remain in the subconjunctival spaces, increasing the risk of glaucoma surgery failure. Early follow-up of glaucoma surgery is crucial to obtaining long-lasting filtration.
PURPOSE: To understand risk factors for failure of glaucoma filtering surgery. PATIENTS: A retrospective study of 67 eyes (16 nonpenetrating trabeculectomies, 51 trabeculectomies [31 with 5FU and 20 with mitomycin]) of 61 patients in whom 5FU bleb revision was needed because of increasing intraocular pressure. Postoperative incidents were analyzed to explain excessive subconjunctival fibroblastic proliferation. RESULTS: In eight cases, IOP increased after 6.16 months (+/-2) and for 59 eyes, after 33.5 days after surgery (+/-11.4). Postoperative incidents were 24 (35.9%) bleb leaks, nine cases (13.4%) of hypotony with choroidal detachment, six (9.0%) iris incarcerations, seven (10.4%) cystic blebs, and 21 (31.3%) inflammatory flat blebs. After a mean follow-up of 27 months +/- 18, the success of bleb 5FU revision was 84.6% for nonpenetrating trabeculectomy (without glaucoma treatment, 69.2%; with medical treatment, 15.4%) and 73.9% for trabeculectomy (47.8% and 32.6%). CONCLUSION: Postoperative outcomes favor an inner or outer obstacle to conjunctival filtration. Aqueous humor can no longer remain in the subconjunctival spaces, increasing the risk of glaucoma surgery failure. Early follow-up of glaucoma surgery is crucial to obtaining long-lasting filtration.