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Clinical and ASOCT evaluations of ‘bleb-sparing epithelial exchange’ in paediatric and adult dysfunctional blebs over 5 years

  • Glaucoma
  • Published:
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Abstract

Purpose

To evaluate the long-term outcome of ‘bleb-sparing epithelial exchange’ surgery for dysfunctional filtering blebs in paediatric and adult eyes.

Methods

Patients who had undergone bleb revision ≥ 5 years back and were on regular follow-up were included. Age, ocular diagnosis, details of primary filtering surgery including mitomycin-C (MMC) usage, indication and year of bleb revision were recorded. After bleb revision, the mean intraocular pressure (IOP), glaucoma medications and best corrected visual acuity (BCVA) up to 5 years were noted. On last review, clinical details, bleb characteristics and swept source anterior segment tomographic (SSOCT) assessment of bleb were recorded. Comparative analysis of paediatric and adult eyes was performed.

Main outcome measures

Change in IOP and BCVA. ‘Complete success’ was defined as IOP ≥ 6 to ≤ 18mmHg without use of any topical glaucoma medications and ‘Qualified success’ when ≥ 1 topical glaucoma medication(s) was required.

Results

A total of 51 eyes of 51 consecutive patients were studied, among which 22 were children. The mean duration between filtering surgery and bleb revision was 4.54 ± 1.53 years in paediatric and 6.48 ± 3.5 years in the adult group, p = 0.04. Children underwent trabeculotomy + trabeculectomy with 0.04% MMC, while adults underwent trabeculectomy with 0.02% MMC. The mean pre-revision IOP was 6.38 ± 2.80 and 6.51 ± 2.78 mmHg in the paediatric and adult group respectively, p = 0.86. At 3 months post-revision, it increased to 11.81 ± 3.48 and 12.75 ± 3.52 mmHg respectively (p < 0.001). At final review, mean IOP of paediatric group was 10.90 ± 2.59 and adult group was 11.86 ± 2.66 mmHg, p = 0.20. At 5 years, complete success was 68.18% and 72.41%, and qualified success was 31.87% and 27.59% in the former and latter group respectively, p = 0.49. No failures were seen. Kaplan-Meier probability at 5 years for IOP target ≤ 18, ≤ 15 and ≤ 12 in children was 95.45%, 63.64% and 50% and in adults 93.10%, 65.52% and 41.38% respectively. BCVA improved up to 1 year in paediatric group, with continued improvement in adults up to 3 years. SSOCT measured bleb height was 0.88 ± 0.37 and 1.32 ± 0.49mm in children versus adults (p = 0.006) and wall thickness, 0.35 ± 0.22 and 0.58 ± 0.24mm respectively, p = 0.008.

Conclusion

Bleb-sparing epithelial exchange is an equally safe and effective technique with good long-term success in both paediatric and adult dysfunctional blebs.

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References

  1. Tham Y-C, Li X, Wong TY, Quigley HA, Aung T, Cheng C-Y (2014) Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology 121:2081–2090

    Article  Google Scholar 

  2. Coleman AL, Miglior S (2008) Risk factors for glaucoma onset and progression. Surv Ophthalmol 53(Suppl1):S3–S10

    Article  Google Scholar 

  3. Mwanza JC, Kabasele PM (2001) Trabeculectomy with and without mitomycin-C in a black African population. Eur J Ophthalmol 11:261–263

    Article  CAS  Google Scholar 

  4. DeBry PW, Perkins TW, Heatley G, Kaufman P, Brumback LC (2002) Incidence of late-onset bleb-related complications following trabeculectomy with mitomycin. Arch Ophthalmol Chic Ill 1960 120:297–300

    Article  CAS  Google Scholar 

  5. Budenz DL, Chen PP, Weaver YK (1999) Conjunctival advancement for late-onset filtering bleb leaks: indications and outcomes. Arch Ophthalmol Chic Ill 1960 117:1014–1019

    Article  CAS  Google Scholar 

  6. Sihota R, Angmo D, Sen S, Gupta V, Dada T, Pandey RM (2016) The long-term outcome of primary “bleb-sparing, epithelial exchange” in dysfunctional filtering blebs. J Glaucoma 25:571–578

    Article  Google Scholar 

  7. Papadopoulos M, Edmunds B, Fenerty C, Khaw PT (2014) Childhood glaucoma surgery in the 21st century. Eye Lond Engl 28:931–943

    Article  CAS  Google Scholar 

  8. Beauchamp GR, Parks MM (1979) Filtering surgery in children: barriers to success. Ophthalmology 86:170–180

    Article  CAS  Google Scholar 

  9. Cantor LB, Mantravadi A, WuDunn D, Swamynathan K, Cortes A (2003) Morphologic classification of filtering blebs after glaucoma filtration surgery: the Indiana Bleb Appearance Grading Scale. J Glaucoma 12:266–271

    Article  Google Scholar 

  10. Ciancaglini M, Carpineto P, Agnifili L, Nubile M, Lanzini M, Fasanella V, Mastropasqua L (2008) Filtering bleb functionality: a clinical, anterior segment optical coherence tomography and in vivo confocal microscopy study. J Glaucoma 17:308–317

    Article  Google Scholar 

  11. Catoira Y, Wudunn D, Cantor LB (2000) Revision of dysfunctional filtering blebs by conjunctival advancement with bleb preservation. Am J Ophthalmol 130:574–579

    Article  CAS  Google Scholar 

  12. Burnstein AL, WuDunn D, Knotts SL, Catoira Y, Cantor LB (2002) Conjunctival advancement versus nonincisional treatment for late-onset glaucoma filtering bleb leaks. Ophthalmology 109:71–75

    Article  Google Scholar 

  13. Radhakrishnan S, Quigley HA, Jampel HD, Friedman DS, Ahmad SI, Congdon NG, McKinnon S (2009) Outcomes of surgical bleb revision for complications of trabeculectomy. Ophthalmology 116:1713–1718

    Article  Google Scholar 

  14. Panday M, Shantha B, George R, Boda S, Vijaya L (2011) Outcomes of bleb excision with free autologous conjunctival patch grafting for bleb leak and hypotony after glaucoma filtering surgery. J Glaucoma 20:392–397

    Article  Google Scholar 

  15. Wang Q, Harasymowycz P (2016) Collagen cross-linking for late-onset bleb leakage: 1-year results. J Glaucoma 25:e273–e276

    Article  Google Scholar 

  16. Sethi P, Patel RN, Goldhardt R, Ayyala RS (2016) Conjunctival advancement with subconjunctival amniotic membrane draping technique for leaking cystic blebs. J Glaucoma 25:188–192

    Article  Google Scholar 

  17. Lee GA, Holcombe DJ (2010) Surgical revision of dysfunctional filtration blebs with bleb preservation, sliding conjunctival flap and fibrin glue. Eye Lond Engl 24:947–953

    Article  CAS  Google Scholar 

  18. Canut MI, Cobián R, Fernández-Vega A, Julio G, Barraquer RI (2019) Long-term follow-up of partial bleb excision in late-onset bleb-related complications by a single surgeon using conjunctival advancement. J Glaucoma. https://doi.org/10.1097/IJG.0000000000001236

    Article  Google Scholar 

  19. Prokosch-Willing V, Lamparter J, Ul Hassan SN, Toshev AP, Pfeiffer N, Hoffmann EM (2018) Results of an adaptive surgical approach for managing late onset hypotony after trabeculectomy with mitomycin C. J Glaucoma 27:307–314

    Article  Google Scholar 

  20. Senthil S, Basia A, Rao HL, Choudhari N, Dikshit S, Mandal AK, Garudadri CS (2018) Outcomes of bleb repair for delayed bleb leaks and sweating blebs. J Glaucoma 27:33–40

    Article  Google Scholar 

  21. Perez CI, Oportus MJ, Mellado F, Valenzuela F, Cartes C, López-Ponce D, Salinas-Toro D, López-Solís R, Traipe L (2017) Algorithm approach for revision surgery following late-onset bleb complications after trabeculectomy: long-term follow-up. Arq Bras Oftalmol 80:25–29

    Article  Google Scholar 

  22. Lin AP, Chung JE, Zhang KS, Chang MM, Orengo-Nania S, Gross RL, Chang PT (2013) Outcomes of surgical bleb revision for late-onset bleb leaks after trabeculectomy. J Glaucoma 22:21–25

    Article  Google Scholar 

  23. Al-Shahwan S, Al-Torbak AA, Al-Jadaan I, Omran M, Edward DP (2006) Long-term follow up of surgical repair of late bleb leaks after glaucoma filtering surgery. J Glaucoma 15:432–436

    Article  Google Scholar 

  24. Tannenbaum DP, Hoffman D, Greaney MJ, Caprioli J (2004) Outcomes of bleb excision and conjunctival advancement for leaking or hypotonous eyes after glaucoma filtering surgery. Br J Ophthalmol 88:99–103

    Article  CAS  Google Scholar 

  25. Bitrian E, Song BJ, Caprioli J (2014) Bleb revision for resolution of hypotony maculopathy following primary trabeculectomy. Am J Ophthalmol 158:597–604.e1

    Article  Google Scholar 

  26. Al Habash A, Aljasim LA, Owaidhah O, Edward DP (2015) A review of the efficacy of mitomycin C in glaucoma filtration surgery. Clin Ophthalmol Auckl NZ 9:1945–1951

    Google Scholar 

Download references

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Authors and Affiliations

  1. Glaucoma Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 110029, India

    Ramanjit Sihota, Harathy Selvan, Talvir Sidhu, Neha Kamble, Dewang Angmo, Suresh Yadav & Tanuj Dada

  2. Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, 110029, India

    Ashish Upadhyay

Authors
  1. Ramanjit Sihota
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  2. Harathy Selvan
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  3. Talvir Sidhu
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  4. Neha Kamble
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  5. Dewang Angmo
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  6. Suresh Yadav
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  7. Tanuj Dada
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  8. Ashish Upadhyay
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Corresponding author

Correspondence to Harathy Selvan.

Ethics declarations

All procedures performed in this study were in accordance to the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

The study was approved by our Institutional Ethics Committee. A written informed consent was obtained from all the adult patients and guardians of the paediatric patients.

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The authors declare that they have no conflict of interest.

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Sihota, R., Selvan, H., Sidhu, T. et al. Clinical and ASOCT evaluations of ‘bleb-sparing epithelial exchange’ in paediatric and adult dysfunctional blebs over 5 years. Graefes Arch Clin Exp Ophthalmol 258, 367–377 (2020). https://doi.org/10.1007/s00417-019-04527-4

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  • DOI: https://doi.org/10.1007/s00417-019-04527-4

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