Late-Onset Bleb Leaks After Glaucoma Filtering Surgery

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Abstract

Objective

To determine the incidence of focal, late-onset, conjunctival bleb leaks after glaucoma filtering surgery.

Design

Prospective, cross-sectional analysis.

Setting

Tertiary care outpatient referral center.

Patients

Consecutive patients who underwent glaucoma filtering surgery prior to June 1996 presenting for evaluation from September 2, 1996, through November 15, 1996. Five hundred twenty-five eyes of 525 consecutive patients were enrolled in the study.

Intervention

Bleb height (elevated or flat), area (diffuse or localized), and wall thickness (thin, thick, or encapsulated) were classified. Each bleb was tested for focal leakage using a moistened fluorescein strip, cobalt blue illumination, and slit-lamp biomicroscopy. Diffuse transconjunctival aqueous flow did not qualify as a focal leak.

Main Outcome Measure

Seidel-positive aqueous leakage.

Results

Bleb leakage occurred in 14 eyes following trabeculectomy (mitomycin C treatment, 10 eyes; 5-fluorouracil treatment, 3 eyes; no antifibrosis agent, 1 eye) and in 1 eye following combined cataract and glaucoma surgery with adjunctive mitomycin C therapy. Bleb leakage occurred more frequently in eyes that received mitomycin C (10 [3.7] of 273 eyes) than 5-fluorouracil (3 [1.4] of 213 eyes) or no antifibrosis agent (1 [2.6] of 39 eyes), using Kaplan-Meier estimates (P=.008, log-rank test). Conjunctival blebs were significantly thinner after trabeculectomy with mitomycin C than with 5-fluorouracil (P=.001). Bleb wall thickness was greater following combined cataract and glaucoma surgery than following trabeculectomy alone (P=.008). Age (P=.84), sex (P=.68), race (P=.77), duration of mitomycin C exposure (P=.62), number of antiglaucoma medications (P=.16), and total 5-fluorouracil dose (P=.85) were not associated with late-onset leaks.

Conclusions

The risk of late-onset focal bleb leakage increases following trabeculectomy with mitomycin C therapy. Late leakage after combined cataract and glaucoma surgery is infrequent.

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