Intermediate Term Outcomes of Early Posttrabeculectomy Bleb Leaks Managed by Large Diameter Soft Bandage Contact Lens.
Gollakota, SriRamani MS *; Garudadri, Chandra S. FRCS *; Mohamed, Ashik MBBS +; Senthil, Sirisha MS, FRCS *
Journal of Glaucoma.
26(9):816-821, September 2017.
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Purpose: To study the outcomes of large diameter soft bandage contact lens (BCL) in managing early trabeculectomy bleb leak.
Materials and Methods: Of 972 eyes that underwent fornix-based trabeculectomy between 2011 and 2015, 19 eyes with bleb leak with at least 1 year follow-up were eligible. Bleb leak was conservatively managed using large diameter BCL (>=15.5 mm in diameter). Success was defined as complete, if bleb leak resolved and the intraocular pressure (IOP) was >=5 and <=18 mm Hg with no additional antiglaucoma medication and failure if surgical intervention was needed.
Results: Mean age ( /-SD) of subjects was 43.5 /-11.9 years. Mitomycin C was used in 15/19 eyes. Median time (interquartile range) from trabeculectomy to bleb leak was 9 days (interquartile range: 8 to 19 d). Bleb leak was treated with 15.5 mm BCL in 16 eyes and 17 mm lens in 3 eyes. Bleb leak resolved with BCL in 17 [89.5%; 95% confidence interval (95% CI), 68.6-97] and 2 eyes (10.5%; 95% CI, 2-31) required bleb resuturing. Mean duration of BCL wear for bleb leak resolution was 23.7 /-8.9 days. Mean IOP increased from 5.8 /-2.7 to 12.5 /-3.1 mm Hg after resolution of bleb leak (P<0.05). At 16 months, complete success probability of trabeculectomy was 89.4% (95% CI, 75.6%-100%).
Conclusions: Large diameter BCL was effective in the management of early bleb leak with good intermediate term success for IOP control. We suggest a trial of soft contact lens of appropriate diameter to manage early bleb leaks, before planning any invasive intervention.
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