PRéCIS:: Treatment of leakage with ocular hypotony after trabeculectomy with MMC can be safely achieved through conjunctival patch alone or combined with donor scleral graft in cases of melted underlying sclera. PURPOSE: To report outcomes of two surgical approaches for treating ocular hypotony in eyes with blebs with late-onset leakage after standard trabeculectomy with Mitomycin C (MMC). METHODS: Thirty consecutive cases with bleb leakage and hypotony underwent bleb revision surgery between 2009 and 2014 by the same surgeon (JW) at the Department of Ophthalmology of the Mainz University Medical Center, Germany. In 18 patients an autologous conjunctival patch graft was applied. In 12 patients the underlying sclera was found melted and an additional scleral donor graft was sutured in place. We analyzed intraocular pressure (IOP), visual acuity and optical coherence tomography (OCT) of the macula preoperatively, at 1 day, 1 week, 4 weeks and 6 months after surgery. RESULTS: Mean IOP was 6.2±3.5▒mmHg preoperatively and 21.7±16.4▒mmHg at 1 day, 13.7±6.7 at one week, 13.1±5.1▒mmHg at 4 weeks, and 12.1±4.7▒mmHg at 6 months after surgery. Visual acuity (logMar) increased from 0.57±0.49 preoperatively to 0.49±0.40 at 6 months. Optical coherence tomography (OCT) showed flattening of macular folds that were present before treatment. No serious adverse event was reported. CONCLUSIONS: This revision technique with conjunctival patch and/or additional donor scleral graft is an effective and safe method for treating late bleb leakage and hypotony maculopathy following trabeculectomy with MMC.
PRéCIS:: Treatment of leakage with ocular hypotony after trabeculectomy with MMC can be safely achieved through conjunctival patch alone or combined with donor scleral graft in cases of melted underlying sclera. PURPOSE: To report outcomes of two surgical approaches for treating ocular hypotony in eyes with blebs with late-onset leakage after standard trabeculectomy with Mitomycin C (MMC). METHODS: Thirty consecutive cases with bleb leakage and hypotony underwent bleb revision surgery between 2009 and 2014 by the same surgeon (JW) at the Department of Ophthalmology of the Mainz University Medical Center, Germany. In 18 patients an autologous conjunctival patch graft was applied. In 12 patients the underlying sclera was found melted and an additional scleral donor graft was sutured in place. We analyzed intraocular pressure (IOP), visual acuity and optical coherence tomography (OCT) of the macula preoperatively, at 1 day, 1 week, 4 weeks and 6 months after surgery. RESULTS: Mean IOP was 6.2±3.5▒mmHg preoperatively and 21.7±16.4▒mmHg at 1 day, 13.7±6.7 at one week, 13.1±5.1▒mmHg at 4 weeks, and 12.1±4.7▒mmHg at 6 months after surgery. Visual acuity (logMar) increased from 0.57±0.49 preoperatively to 0.49±0.40 at 6 months. Optical coherence tomography (OCT) showed flattening of macular folds that were present before treatment. No serious adverse event was reported. CONCLUSIONS: This revision technique with conjunctival patch and/or additional donor scleral graft is an effective and safe method for treating late bleb leakage and hypotony maculopathy following trabeculectomy with MMC.