Abstract #81049 Published in IGR 20-3

Incision-Free Minimally Invasive Conjunctival Surgery (MICS) for Late Onset Bleb Leaks After Trabeculectomy (An American Ophthalmological Society Thesis)

Gupta N
American Journal of Ophthalmology 2019; 207: 333-342

PURPOSE: To describe an incision-free minimally invasive conjunctival surgical (MICS) technique to repair late onset leaking blebs after trabeculectomy. METHODS: A surgical technique to repair leaking blebs without incision or excision of conjunctiva is described. This is followed by retrospective review of all patients treated at the Glaucoma Unit at St. Michael's Hospital for bleb leaks repaired with MICS from 2012 to 2017. With REB approval, clinical data obtained from the charts included demographic information, vision, intraocular pressure (IOP) data before and after surgery, need for additional medication, and complications. Resolution of the bleb leak without the need for additional therapy or intervention for glaucoma control was considered a success. RESULTS: The MICS described approach was applied to 14 eyes of 13 consecutive patients with a leaking bleb. Mean age of presentation was 70.2 ± 14.8 yrs and all patients had of history of mitomycin use at the time of glaucoma surgery. The onset of bleb leak following trabeculectomy ranged from 7 months to 16.3 years. Mean pre-operative IOP was 4.5 ± 2.8 mmHg, and immediately after the procedure, IOP measured 12.3 ± 3.0 mmHg. Complete resolution of the bleb leak was observed following surgery in all cases. Follow-up period ranged from 2 weeks to 61 months (10.2 ± 18.1). Recurrent bleb leak was reported in one patient two years following initial surgery. In all cases, the initially repaired filtering blebs remained functional at last follow-up and no medications were required. CONCLUSIONS: The MICS procedure is an effective option for treating the late-onset leaking bleb without cutting or excising conjunctival tissue. The minimal requirements of this method make it additionally accessible to low resource settings.

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12.8.1 Without tube implant (Part of: 12 Surgical treatment > 12.8 Filtering surgery)

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