Journal of Ophthalmology

Research Article

Surgical Management for Refractory Bleb Dysesthesia

Table 2

Literature review of surgical management of circumferential, dysesthetic bleb after glaucoma filtering surgery.

Study

Type

Sex

Age

Primary proc

Time to Sx

Type of Sx

Comp ReSx

Presx IOP

IOP 24 h

IOP 1 m

IOP 3 m

IOP 6 m

IOP 12 m

Final IOP

Success (%)

Meds

F-U

S Begum et al. [5]

Retro case series

6F 1M

67 (60–77)

T + MMC

18 m

Bleb compression sutures, autologous blood

2 needlings

11 ± 2.7

N/A

11 ± 2.5

11.1 ± 2.5

N/A

12 ± 4.7

N/A

29.4 ± 23.7 m

JE Morgan et al. [7]

Retro case series

5F 6M

68 (47–78)

461 d (41–2023)

Bleb compression sutures, autologous blood

8 autologous blood

6.7 (0–12)

17.3 (9–25)

N/A

11.3 (5–16)

N/A

45 w (8–81)

D Faingold et al. [8]

Retro rev

N/A

T + MMC/T + MMC + P

3 ± 2 m

Transconj trab flap suturing

2 resx, 1 leak

4.2 ± 0.6

N/A

8. 7 ± 3.5

100%

N/A

40.7 ± 17.5 m

IC l-Harazi et al. [9]

Retro rev

4F 5M

71 (56–81)

Bleb window cryopexy

1 misdirection

13.9 (8–26)

N/A

13.4 (10–16)

89%

15.5 m (5–26)

R Tabet et al. [10]

Retro rev

5F 1M

57.1 ± 12.4

4 T + MMC, 2 T + 5FU

1.6 ± 1.8 y

“Bleb window”-pexy

9.8 ± 4.4

10.33 ± 4.4

10.0 ± 4.7

9.5 ± 4.4

11 ± 6.2

12.2 ± 2

100%

6.6 ± 1.7 m (3.5 to 8.3)

MI Canut et al. [11]

Retro case series

3F 4M

63 (44–78)

T + MMC, T + MMC+, NPDS + MMC + SK-gel + P, NPDS + SK-gel

32 (24–108) m

Partial bleb excision + conj advancement

1 filtering sx

14.0 (8–18)

14.8 ± 3.5

14.9 ± 3

N/A

15.6 ± 6.1

N/A

43% (3/7)

43.7 ± 29.9 m

S Radhakrishnan et al. [12]

Retro case series

90F (54%)

67 ± 14

T (69%) + MMC (58%) + P (24%)

3.5 ± 3.7 y

Excision of the entire bleb (22) or partial (6) with conj advancement

3 filtering sx, 2 resx, 6 still pain, 3 other (blebitis)

11.9 ± 4.7

N/A

13.4 ± 5.9

57% (16/28)

2.8 ± 2.7 y

CC Schnyder et al. [13]

Retro rev

12F 4M

62 ± 15.4

1 T MMC, 1 T

31 ± 12.7 m

Bleb reduction and free conjunctival autologous graft

1 needling

10 ± 4.2

N/A

12 ± 2.8

38.3%

23 ± 1.4 m

GA Lee et al. [14]

Retro case series

T + MMC/5FU

N/A

Bleb revision with sliding conj flap and fibrin glue

N/A

100%

31 m

SE LaBorwit et al. [15]

Retro case series

18F 13M

57 (14–82)

8 T/3 T P
5 MMC/2 5FU

2.8 ± 2 y

Bleb reduction (excision with conjunctiva advancement in 10 and conjunctival autograft in 1)

5 resx

11.5 ± 4.3

N/A

13.2 ± 4.6

N/A

18.1 ± 11.7 m

EJ van de Geijn et al. [16]

Retro rev

17F 1M

59.6 (21–79)

T + MMC (75%)

14.5 ± 12 m

Bleb excision and conjunctiva and Tenon advancement

11 ± 4.2

N/A

11 ± 0

100%

52 ± 11.3 m

Y Catoira et al. [17]

Retro rev

12F 18M

45.3 ± 21

1 T, 1 T P, 1 T MMC

29.1 m (3–114)

Bleb revision by conj advancement

6.6% ptosis, 13% hypertropia

12.7 ± 1.2

N/A

17 ± 3.5

67%

17.3 ± 23.2 m

S Anis et al. [3]

Retro rev

7F 8M

67.6 (51–81)

T + MMC/5FU

2.6 ± 3.0 y (3 m-8.6 y)

Bleb-limiting conjunctivoplasty

1 leak resolved spontaneously

9.4 ± 4.7

N/A

9.2 ± 5.0

N/A

10.2 ± 6.6

N/A

93.3%

>3 m

M Lloyd et al. [4]

Retro rev

3F 8M

60 ± 11.0

T + MMC

24 w (11 w-16 m)

Bleb-limiting conjunctivoplasty with removal of subconj scar tissue

10.6 ± 3.4

N/A

12.8 ± 5.3

11.8 ± 4.8

11.5 ± 2.7

12.6 ± 3.1

N/A

100%

>1 y

R Rahman et al. [18]

Case series

67 ± 5.7

2 T

24 ± 17 m

Bleb-limiting conjunctivoplasty

1 resx

12 ± 4.4

N/A

14 ± 4.2

N/A

9.5 ± 3.5 m

N: number of eyes included, primary proc-primary procedure, sx: surgery, Comp: complications, resx: resurgery, presx: presurgery, IOP (mmHg): intraocular pressure (millimeters of mercury), preop.: preoperatively, Meds: antiglaucoma medications, F-U: follow-up, retro: retrospective study, rev-revision, F: feminine, M: masculine, T: trabeculectomy, MMC: mitomycin C, P: phacoemulsification, 5FU: 5 fluorouracil, NPDS: nonpenetrating deep sclerectomy, d: days, w: weeks, m: months, y: years, N/A: not available. D Faingold et al. A complete success was defined as achieving a total resolution of the choroidal effusions or a total resolution of symptoms related to dysesthesia without the addition of IOP-lowering drops. IC l-Harazi et al. Success was defined as subjective relief of symptoms, adequate control of the IOP (no greater than 16 mm Hg), and restoration of filtering bleb function without further antiglaucoma medications or surgical bleb revision. R Tabet et al. Complete success was defined as complete resolution of symptoms and flattening of the interpalpebral portion of the bleb while maintaining an IOP between 8 and 20 mm Hg without further antiglaucoma medications or surgical bleb revision. MI Canut et al. Complete success defined as maintenance of individual target IOP without a second revision, surgery, or glaucoma medications. S Radhakrishnan et al. Successful outcome was defined as elimination of primary indication, no requirement for further intraocular pressure- (IOP-) lowering surgery, no major complication, and no development of new bleb-related complication. CC Schnyder et al. The complete success rate was defined by an IOP >6 mm Hg and <21 mm Hg, with a visual acuity equal to or better than the preoperative visual acuity without any glaucoma medication. GA Lee et al. A successful outcome was defined as the resolution of the presenting indication for revision, with maintenance of IOP with the same or reduced number of glaucoma medications in the absence of further glaucoma surgery. EJ van de Geijn et al. Surgical success was defined as a final intraocular pressure between 6 and 22 mm Hg with or without topical antiglaucoma medication, resolution of symptoms, and no need for repeat glaucoma surgery (except for repeat revision surgery). Y Catoira et al. Success was defined as resolution of the bleb-associated complication necessitating the revision (discomfort) with maintenance of intraocular pressure greater than or equal to 6 and less than or equal to 21 mm Hg without glaucoma medications. S Anis et al. Success criteria were defined as subjective resolution of symptoms and maintenance of IOP with no subsequent surgical intervention. M Lloyd et al. Bleb functionality defined as adequate IOP control without further surgery. The whole studied cohort.