Bleb revision shows good results in hypotony maculopathy

This retrospective study found that bleb revision can provide long-term vision improvement and IOP control in patients with post-trabeculectomy hypotony maculopathy.

This study adds to the relatively small body of research regarding bleb revision, and shows favorable IOP and BCVA outcomes after conjunctival advancement following overfiltering blebs with hypotony maculopathy. It is important because while various methods have been utilized in the past for hypotony maculopathy with overfiltering blebs, such as compression sutures, trans-conjunctival flap sutures, large contact lenses and autologous blood, this is the largest study with the longest follow-up period to analyze bleb revision for this purpose. 

The authors reviewed the charts of 33 patients with trabeculectomy-induced hypotony maculopathy who underwent primary bleb revision between June 1999 and September 2012 performed by a single surgeon at an academic medical center. The mean duration of hypotony maculopathy prior to bleb revision was five months. 

At a mean follow-up of 4.7 years after bleb revision, 88 percent of patients showed improvement in BCVA, 94% experienced a sustained increase in IOP and 52% did not require glaucoma medications to maintain therapeutic IOPs. A second bleb revision surgery was required in five cases (15%) to achieve a target IOP at which hypotony maculopathy would not recur. None of the study patients required a second glaucoma surgery to treat elevated IOP.

The authors conclude that further studies are needed to determine the duration of hypotony for which treatment is still effective in restoring visual function should the surgeon elect to try more conservative measures first.