Frequency of bleb manipulations following trabeculectomy surgery

Abstract

Aim: To quantify the type and frequency of postoperative bleb manipulations undertaken following modern glaucoma surgery.

Methods: Bleb manipulations were recorded following trabeculectomy surgery on 119 consecutive patients with at least one year follow-up. The type of intervention and time following surgery were recorded. Statistical analysis identified success rates at various intraocular pressure (IOP) cut-off definitions and identified factors that increased the risk for bleb manipulation.

Results: In total 78.2% of trabeculectomies were followed by some form of bleb manipulation. Almost 49% of blebs underwent massage and a similar number required at least one suture removal, 31.1% required at least one 5 flourouracil (5-FU) injection and 25.2% required at least one needling + 5-FU injection. The median time to the first intervention for massage, suture removal, 5-FU injection and needling + 5-FU injection were 1, 14, 14 and 43 days respectively. IOP measurements were higher at all follow-up time points in the intervention group. Failure to achieve specific IOP target pressures was also generally poorer in the 5-FU and needling + 5FU intervention groups.

Conclusions: Postoperative intervention is a frequent occurrence following modern glaucoma surgery. This requires intensive postoperative follow-up and is a labour intensive undertaking. Despite interventions in our group of patients IOP in the intervention group was always higher than the group that required no intervention.