Abstract

Hypotony, resulting from excessive filtration following trabeculectomy, poses a significant risk of permanent visual impairment if not promptly addressed. This video presentation introduces specialized surgical techniques for the reversal of hypotony. Over-filtering bleb and dysesthetic overhanging blebs without leakage can be effectively managed through transconjunctival or compression sutures. Ischemic blebs benefit from interventions such as crescent-assisted epithelial debridement and conjunctival overlay. In cases of insufficient conjunctiva for coverage post-bleb excision, conjunctival autografts or pedicle rotation grafts offer valuable solutions. Scleral defects necessitate scleral patch grafts, lamellar scleral grafts, or the application of biodegradable collagen implants to provide tectonic support.
By understanding and applying these interventions on a case-by-case basis, clinicians can restore ocular integrity and safeguard against further visual impairment.