Algorithm approach for revision surgery following late-onset bleb complications after trabeculectomy: long-term follow-up

Detalhes bibliográficos
Autor(a) principal: Perez,Claudio I.
Data de Publicação: 2017
Outros Autores: Oportus,María J., Mellado,Felipe, Valenzuela,Felipe, Cartes,Cristián, López-Ponce,Daniela, Salinas-Toro,Daniela, López-Solís,Remigio, Traipe,Leonidas
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Arquivos brasileiros de oftalmologia (Online)
Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-27492017000100008
Resumo: ABSTRACT Purpose: The aim of this study was to introduce a reproducible algorithm for the surgical management of late-onset (>2 months) bleb complications after trabeculectomy with mitomycin C. Methods: We performed a retrospective review of eyes treated using a reproducible algorithm approach by a single surgeon for the surgical management of late-onset bleb complications from July 2006 to April 2014. Exclusion criteria were bleb revision with less than 3 months of follow-up or bleb revision combined with other glaucoma procedures at the time of surgery. Success was evaluated using the Kaplan-Meier survival method and defined as achieving all of the following criteria: primary surgery indication resolved, no additional surgery required for decreasing the intraocular pressure (IOP), and IOP of ≥6 mmHg and ≤18 mmHg. Results: Twenty-three eyes from 20 patients were evaluated. Indications for bleb revision were hypotonic maculopathy (47.8%), bleb leak (30.4%), and dysesthetic bleb (21.7%). The overall primary outcome success rate calculated using the Kaplan-Meier survival method was 65.2% at 48 months. When the IOP target was changed to ≤15 mmHg, the bleb survival rate was 47.8% at 48 months. At the most recent postoperative visit, 95.7% of eyes had an IOP of ≤15 mmHg and 56.5% were being treated with an average of one medication per eye. One eye (4.3%) required a second bleb revision for persistent hypotony and two eyes required glaucoma surgery to reduce IOP during follow-up. Conclusions: An algorithm approach for the surgical management of late-onset bleb complications with a success rate similar to those reported in specialized literature is proposed. Randomized trials are needed to confirm the best surgical approach.
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spelling Algorithm approach for revision surgery following late-onset bleb complications after trabeculectomy: long-term follow-upIntraocular pressureGlaucoma surgeryTrabeculectomyPostoperativeMitomycin CABSTRACT Purpose: The aim of this study was to introduce a reproducible algorithm for the surgical management of late-onset (>2 months) bleb complications after trabeculectomy with mitomycin C. Methods: We performed a retrospective review of eyes treated using a reproducible algorithm approach by a single surgeon for the surgical management of late-onset bleb complications from July 2006 to April 2014. Exclusion criteria were bleb revision with less than 3 months of follow-up or bleb revision combined with other glaucoma procedures at the time of surgery. Success was evaluated using the Kaplan-Meier survival method and defined as achieving all of the following criteria: primary surgery indication resolved, no additional surgery required for decreasing the intraocular pressure (IOP), and IOP of ≥6 mmHg and ≤18 mmHg. Results: Twenty-three eyes from 20 patients were evaluated. Indications for bleb revision were hypotonic maculopathy (47.8%), bleb leak (30.4%), and dysesthetic bleb (21.7%). The overall primary outcome success rate calculated using the Kaplan-Meier survival method was 65.2% at 48 months. When the IOP target was changed to ≤15 mmHg, the bleb survival rate was 47.8% at 48 months. At the most recent postoperative visit, 95.7% of eyes had an IOP of ≤15 mmHg and 56.5% were being treated with an average of one medication per eye. One eye (4.3%) required a second bleb revision for persistent hypotony and two eyes required glaucoma surgery to reduce IOP during follow-up. Conclusions: An algorithm approach for the surgical management of late-onset bleb complications with a success rate similar to those reported in specialized literature is proposed. Randomized trials are needed to confirm the best surgical approach.Conselho Brasileiro de Oftalmologia2017-01-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-27492017000100008Arquivos Brasileiros de Oftalmologia v.80 n.1 2017reponame:Arquivos brasileiros de oftalmologia (Online)instname:Conselho Brasileiro de Oftalmologia (CBO)instacron:CBO10.5935/0004-2749.20170008info:eu-repo/semantics/openAccessPerez,Claudio I.Oportus,María J.Mellado,FelipeValenzuela,FelipeCartes,CristiánLópez-Ponce,DanielaSalinas-Toro,DanielaLópez-Solís,RemigioTraipe,Leonidaseng2017-03-27T00:00:00Zoai:scielo:S0004-27492017000100008Revistahttp://aboonline.org.br/https://old.scielo.br/oai/scielo-oai.phpaboonline@cbo.com.br||abo@cbo.com.br1678-29250004-2749opendoar:2017-03-27T00:00Arquivos brasileiros de oftalmologia (Online) - Conselho Brasileiro de Oftalmologia (CBO)false
dc.title.none.fl_str_mv Algorithm approach for revision surgery following late-onset bleb complications after trabeculectomy: long-term follow-up
title Algorithm approach for revision surgery following late-onset bleb complications after trabeculectomy: long-term follow-up
spellingShingle Algorithm approach for revision surgery following late-onset bleb complications after trabeculectomy: long-term follow-up
Perez,Claudio I.
Intraocular pressure
Glaucoma surgery
Trabeculectomy
Postoperative
Mitomycin C
title_short Algorithm approach for revision surgery following late-onset bleb complications after trabeculectomy: long-term follow-up
title_full Algorithm approach for revision surgery following late-onset bleb complications after trabeculectomy: long-term follow-up
title_fullStr Algorithm approach for revision surgery following late-onset bleb complications after trabeculectomy: long-term follow-up
title_full_unstemmed Algorithm approach for revision surgery following late-onset bleb complications after trabeculectomy: long-term follow-up
title_sort Algorithm approach for revision surgery following late-onset bleb complications after trabeculectomy: long-term follow-up
author Perez,Claudio I.
author_facet Perez,Claudio I.
Oportus,María J.
Mellado,Felipe
Valenzuela,Felipe
Cartes,Cristián
López-Ponce,Daniela
Salinas-Toro,Daniela
López-Solís,Remigio
Traipe,Leonidas
author_role author
author2 Oportus,María J.
Mellado,Felipe
Valenzuela,Felipe
Cartes,Cristián
López-Ponce,Daniela
Salinas-Toro,Daniela
López-Solís,Remigio
Traipe,Leonidas
author2_role author
author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Perez,Claudio I.
Oportus,María J.
Mellado,Felipe
Valenzuela,Felipe
Cartes,Cristián
López-Ponce,Daniela
Salinas-Toro,Daniela
López-Solís,Remigio
Traipe,Leonidas
dc.subject.por.fl_str_mv Intraocular pressure
Glaucoma surgery
Trabeculectomy
Postoperative
Mitomycin C
topic Intraocular pressure
Glaucoma surgery
Trabeculectomy
Postoperative
Mitomycin C
description ABSTRACT Purpose: The aim of this study was to introduce a reproducible algorithm for the surgical management of late-onset (>2 months) bleb complications after trabeculectomy with mitomycin C. Methods: We performed a retrospective review of eyes treated using a reproducible algorithm approach by a single surgeon for the surgical management of late-onset bleb complications from July 2006 to April 2014. Exclusion criteria were bleb revision with less than 3 months of follow-up or bleb revision combined with other glaucoma procedures at the time of surgery. Success was evaluated using the Kaplan-Meier survival method and defined as achieving all of the following criteria: primary surgery indication resolved, no additional surgery required for decreasing the intraocular pressure (IOP), and IOP of ≥6 mmHg and ≤18 mmHg. Results: Twenty-three eyes from 20 patients were evaluated. Indications for bleb revision were hypotonic maculopathy (47.8%), bleb leak (30.4%), and dysesthetic bleb (21.7%). The overall primary outcome success rate calculated using the Kaplan-Meier survival method was 65.2% at 48 months. When the IOP target was changed to ≤15 mmHg, the bleb survival rate was 47.8% at 48 months. At the most recent postoperative visit, 95.7% of eyes had an IOP of ≤15 mmHg and 56.5% were being treated with an average of one medication per eye. One eye (4.3%) required a second bleb revision for persistent hypotony and two eyes required glaucoma surgery to reduce IOP during follow-up. Conclusions: An algorithm approach for the surgical management of late-onset bleb complications with a success rate similar to those reported in specialized literature is proposed. Randomized trials are needed to confirm the best surgical approach.
publishDate 2017
dc.date.none.fl_str_mv 2017-01-01
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
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dc.identifier.uri.fl_str_mv http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-27492017000100008
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dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv 10.5935/0004-2749.20170008
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dc.publisher.none.fl_str_mv Conselho Brasileiro de Oftalmologia
publisher.none.fl_str_mv Conselho Brasileiro de Oftalmologia
dc.source.none.fl_str_mv Arquivos Brasileiros de Oftalmologia v.80 n.1 2017
reponame:Arquivos brasileiros de oftalmologia (Online)
instname:Conselho Brasileiro de Oftalmologia (CBO)
instacron:CBO
instname_str Conselho Brasileiro de Oftalmologia (CBO)
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institution CBO
reponame_str Arquivos brasileiros de oftalmologia (Online)
collection Arquivos brasileiros de oftalmologia (Online)
repository.name.fl_str_mv Arquivos brasileiros de oftalmologia (Online) - Conselho Brasileiro de Oftalmologia (CBO)
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