Results of medical management and mitomycin C-augmented excisional bleb revision for encapsulated filtering blebs.

BACKGROUND AND OBJECTIVE

To assess the outcome of medical management and mitomycin C (MMC)-augmented excisional bleb revision (EBR) for encapsulated filtering blebs.

PATIENTS AND METHODS

The author conducted a retrospective study of 503 patients who had undergone trabeculectomy performed over a 5 year period, followed up for at least one year, in order to identify the encapsulated filtering blebs. Mitomycin C-augmented (0.4mg/ml for 3 minutes) EBR was performed in cases of failed medical therapy for managing encapsulated blebs consisting of antiglaucoma medications, topical steroids, and digital compression.

RESULTS

An encapsulated bleb developed in 18 eyes (3.6%) of 503 patients. Identification of bleb encapsulation occurred at a mean follow-up time of 24.2 +/- 10.4 days after surgery. The mean intraocular pressure (IOP) at that point was 30.4 +/- 11.7 mmHg in the affected eyes. Fifteen (83.3%) of 18 eyes responded to conservative management and 3 eyes (16.7%) required MMC augmented EBR. The mean IOP reduced from 30.4 +/- 11.7 mmHg to 14.2 +/- 4.2 mmHg after a mean follow-up of 37.6 +/- 11.4 months in the conservative management group, while it reduced from 37.3 +/- 23.4 mmHg to 12.0 +/- 4.4 mmHg after a mean follow-up of 42 +/- 6 months in the surgically treated group. None of the surgically treated eyes developed MMC-related complications.

CONCLUSION

Conservative management is very effective in the treatment of encapsulated filtering blebs. The intraoperative use of MMC is a safe and effective adjunct in EBR in cases where conservative management has failed.