Trabeculectomy/Bleb Revision Technique
Title: Trabeculectomy/Bleb Revision Technique
Author: Austin Nakatsuka, MD
Keywords/Main Subjects: Trabeculectomy
Failed trabeculectomy bleb. Generally more successful when the flap is visible and there is less scar tissue overlying the flap, itself.
30 gauge needle
0.2 mg/mL (or 0.4) Mitomycin C injected posterior prior to surgery.
Prior to surgery, ~0.1 cc mitomycin c is injected posterior to the bleb.
A 7-0 vicryl traction suture is placed in the cornea at about 75 to 90% depth. The flap is identified. The needle is bent with the hemostat at a 45 to 90 degree angle with the bevel DOWN to facilitate access. The needle is entered a few millimeters posterior to the flap and advanced forward to the flap. The needle is used to very gentle lift the flap and then advanced forward into the anterior chamber and swept left to right to break up adhesions. The needle is then withdrawn but kept subconjunctival. Multiple passes are then made in the bleb space, essentially poking holes into underlying tenon’s capsule and cyst to allow diffusion posteriorly and diffusely. The iop is checked with digital pressure to ensure that IOP is not too low or too high. Additional BSS fluid can be injected through a paracentesis incision if the eye has been decompressed too much. Once adequate flow has been established, the traction suture is removed.