Surgical Outcomes of a Small Incision Limbus-Based Revision for Failed Trabeculectomies

Background: Trabeculectomy does not always work as long as necessary to control glaucoma. This study aimed to describe the initial outcomes of a surgical technique for restoring failed trabeculectomies. Methods: We reviewed patients with failed trabeculectomy with mitomycin (MMC) who underwent limbus-based revision. After the dissection of the subconjunctival area through a smaller incision (3 mm), MMC was applied and episcleral fibrosis was excised. Each criterion was classified as complete or qualified for glaucoma medication. Results: Nineteen patients (19 eyes) were included in this study. The mean follow-up was 9.4 ± 8.6 months. At the last follow-up visit, the mean intraocular pressure was reduced from 20.9 ± 8.4 (range, 12 - 44 mmHg) to 11.6 ± 3.6 mm Hg (range, 6 - 19 mmHg) (p < 0.01). The mean number of glaucoma medications was reduced from 2.6 ± 0.8 to 0.4 ± 0.7 during the same period (p < 0.01). At 6 months postoperatively, the qualified success rate was 68% and 85% for stricter and less strict criteria, respectively. Two cases of transient leakage and reoperation were required in three eyes. No sight-threatening complications were noted. Conclusions: Our initial results suggest that limbus-based revision is an effective alternative to restoring failed trabeculectomies with minor postoperative complications.