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Filtering Bleb Failure
- Predisposing factors of filtering bleb failure:
- Previous surgery and resulting subconjunctival fibrosis
- Previous filtering bleb failure
- Long-term medical therapy
- Neovascular glaucoma
- Intraoperative complications (e.g. iris or ciliary process incarceration in the trabeculectomy fistula).
- Early signs of a failing filtering bleb:
- Gradual IOP elevation during the first 2-4 weeks
- Excessive vascularization of the bleb
- Flattening of the bleb with the disappearance of microcysts in the bleb
- Retrospective studies have indicated that filtration surgery is more likely to be successful in older patients, patients without African heritage, and those without previous long-term medical therapy.
- Intra- or postoperative anti proliferative therapy (such as 5-fluorouracil or mitomycin-C) to decrease the likelihood of an aggressive postoperative fibroblast-mediated scarring process.
- Sub-tenon's corticosteroid injections may be administered intra- or post-operatively.
- Selective applications of digital pressure to the bleb should also be considered to promote aqueous flow into the subconjunctival space, thereby elevating the filtration bleb.