Clinical characteristics and leakage of functioning blebs after trabeculectomy with mitomycin-C in primary glaucoma patients

Ophthalmology. 2003 Feb;110(2):345-52. doi: 10.1016/S0161-6420(02)01739-6.


Purposes: To describe the clinical characteristics of functioning blebs in Japanese glaucoma patients after primary trabeculectomy with adjunctive mitomycin-C (MMC) and to correlate their associations with postoperative bleb leakage.

Design: A prospective, observational case series.

Participants: One hundred sixty-two glaucoma patients who had undergone primary trabeculectomy with MMC at the University of Tokyo Hospital at least 3 months before were examined between December 1997 and February 1998.

Methods: A predesigned data form was completed at each visit. Ophthalmologic examinations included Goldmann applanation tonometry, slit-lamp examination, and Seidel tests with and without digital ocular pressure (DOP).

Main outcome measures: Properties of the functioning bleb, including bleb appearance, thickness of bleb wall, dimensions of bleb and avascular area, and leakage status with and without DOP.

Results: Of 162 Japanese patients, 162 eyes with functioning blebs were included. There were no differences in bleb characteristics among the different types of primary glaucoma. With a long postoperative duration, blebs tended to be thinner (P = 0.024). With DOP, the leaking rate increased from 3.1% to 5.6%, and the oozing rate increased from 11.1% to 35.8% (P < 0.001). Logistic regression analysis indicated that the larger the avascular area, the more likely the bleb leaked without DOP (P = 0.016). When DOP was applied, leakage was more likely to occur in the blebs with a long postoperative duration (P = 0.002) or with a large avascular area (P < 0.001).

Conclusions: The clinical characteristics of filtering blebs were similar in Japanese patients with different types of primary glaucoma. Blebs with a large avascular area were associated with a higher risk of bleb leakage. Attention to the increased chance of leakage induced by DOP is important, especially for blebs with a long postoperative duration. Ophthalmologists should be aware of late bleb-related complications in addition to bleb function.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antibiotics, Antineoplastic / administration & dosage*
  • Aqueous Humor / metabolism
  • Combined Modality Therapy
  • Female
  • Glaucoma, Angle-Closure / drug therapy
  • Glaucoma, Angle-Closure / surgery*
  • Glaucoma, Open-Angle / drug therapy
  • Glaucoma, Open-Angle / surgery*
  • Humans
  • Intraocular Pressure
  • Male
  • Middle Aged
  • Mitomycin / administration & dosage*
  • Postoperative Complications / metabolism*
  • Postoperative Complications / pathology
  • Prospective Studies
  • Sclera / blood supply
  • Sclera / metabolism
  • Sclera / pathology
  • Tonometry, Ocular
  • Trabeculectomy / adverse effects*


  • Antibiotics, Antineoplastic
  • Mitomycin