Fibrin sealant in the management of complicated hypotony after trabeculectomy.

BACKGROUND AND OBJECTIVE

In the postoperative course of trabeculectomy, hypotony may cause choroidal detachment with shallowing of the anterior chamber. If conservative medical treatment fails, a surgical revision may become necessary. To achieve only a temporary seal of the scleral flap, a subconjunctival tamponade with fibrin glue was performed.

PATIENTS AND METHODS

Two patients with corneal decompensation as a result of cornea-lens contact complicating hypotony with massive choroidal detachment are described. Hypotony occurred after trabeculectomy in one case and after combined cataract and glaucoma surgery in another case, and was not correlated to a leaking bleb. Temporary tamponade of the scleral flap was achieved by subconjunctival injection of fibrin sealant.

RESULTS

After the fibrin sealant was applied, the choroidal detachment resolved and intraocular pressure increased to normal. During the follow-up period of 6 months, a functioning bleb developed.

CONCLUSION

Subconjunctival application of fibrin sealant is effective for temporary closure of the scleral flap after trabeculectomy in eyes with massive hypotony syndrome.