Nick Strouthidis MBBS MD PhD FRCS FRCOphth FRANZCO

REVISION SURGERY

What Is Revision Surgery?

Revision surgery is an umbrella term for any kind of surgical intervention that is used to try to get a tube or trabeculectomy to work again or to reverse any form of complication associated with glaucoma drainage surgery.

Trabeculectomy Revision

If trabeculectomy surgery fails, then it is possible to try to get it working again by 'needling' to cut away the scar tissue. Occasionally, it is possible to open up the previous trabeculectomy trap door to get it to start working again. Repeat or redo trabeculectomies are not, however, associated with a high long-term success rate so tube surgery is usually offered where a trabeculectomy followed by multiple needlings has failed.

Occasionally trabeculectomies may become uncomfortable, may leak aqueous (thereby increasing the chances of infection) or have chronically low pressures causing poor vision. In these cases, complex revision surgery (often requiring donor graft material) may be required to reverse the problem whilst still trying to maintain trabeculectomy function (ie long term IOP control).

Revision Of Tubes

Tube revision surgery is required if the tube erodes, requiring donor patching, or if the tube needs to be resited. Tubes which are overdraining (IOP too low) may need to be explored surgically and have a ligating suture added or a stent (such as supramid) inserted into the tube lumen.

Often eyes with tubes have had multiple surgeries making revision surgery difficult; surgery on these eyes requires a great deal of experience to prevent further complications and to ensure a good outcome.