Abstract

Trabeculectomy is still the gold standard glaucoma care procedure. Completion of trab is beginning of several interventions in case of failing bleb.So, real challenges start after the surgery. For Initial 2 to 4 weeks, frequent monitoring is essential for identifying the signs of failing bleb. So, timely intervention can rescue the failing bleb.
Approach to failing bleb-
1. Topical corticosteroids- intensify in early period if signs of failing present. Continue for at least 3 months in tapering fashion
2. Suture manipulation and Ocular massage- within first week bleb massage can be attempted by physician
Teaching bleb massage to the patient is not always safe. Unsupervised bleb massage by patient can lead to complications. There is no rule of thumb for ideal time to remove or lyse the suture
3. Subconjunctival 5-FU is given alone or along with bleb needling
4. Bleb needling – effective in encapsulated bleb. Inner scleral ostium should be patent. Can be done on slit lamp or in OR.