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Management of the failing filter.

A 50-year-old Afro-Caribbean patient with moderate disk damage caused by primary open-angle glaucoma underwent an uncomplicated right trabeculectomy with mitomycin C (0.2 mg/mL applied for 3 minutes) because of inadequate control with medical therapy. A standard 3 by 4-mm scleral flap was sutured with one fixed and one releasable suture. The aim was to achieve a target intraocular pressure (IOP) of less than 15 mm Hg. For the first 2 weeks after surgery, the IOP varied between 12 and 18 mm Hg, and a good bleb was noted. By 3 weeks, however, despite a large bleb, the IOP had risen to 25 mm Hg. The releasable suture was removed and gentle pressure was applied to the sclera adjacent to the bleb, which facilitated drainage of aqueous and resulted in an IOP of 12 mm Hg. After an additional 2 weeks, the IOP was again elevated (measuring 28 mm Hg), and a large encapsulated bleb was present.