Mitomycin C has improved the success rate of glaucoma filtering surgery in patients at high risk for surgical failure. However chronic hypotony is marked by decreased vision and a late-onset leaking bleb after filtration surgery using mitomycin
C.
Bleb
excision and conjunctival advancement is the method of choice to repair bleb leakage and chronic hypotony. Five eyes from five patients were received glaucoma filtration surgery with topical mitomycin C. All of the patients' blebs were avascular
and
transparent. The reasons for bleb excision were two spontaneous bleb leaks, two traumatic bleb leaks and one case of severe irritation. The mean follow-up period was 18.4± 8.3 months (ten to 29 months). Cataract surgery was combined in one eye.
Postoperative intraocular pressure (IOP) increased from 2.3± 1.5 ㎜Hg to 9.5± 3.7 ㎜Hg at nine months postoperatively in four eyes. It went from 28 ㎜Hg to 40 ㎜Hg in one patient with uveitis, for whom a second trabeculectomy with mitomycin C;
0.4
㎎/㎖ for 3 minutes, was performed. After surgery, IOP decreased to 4 ㎜Hg in three months. Postoperative visual acuity improved four snellen lines in three eyes. A partially avascular bleb recurred in three eyes, a corneal bleb in one eye and
blepharoptosis, which disappeared spontaneously at four months postoperatively, in one eye. Necrotic bleb excision and advancement of fornical conjunctiva were useful methods to increase IOP and to improve visual acuity for the patient
experiencing
irritation symptoms, and for leaking blebs, and hypotonic maculopathy.
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