Are there any special considerations when approaching ptosis repair in a patient with a prior trabeculectomy?

I have two main concerns with trabeculectomy patients (or any glaucoma filtering procedure). The first is avoiding overcorrection of ptosis, which can expose the bleb and increase the risk of blebitis. The second is respecting the conjunctiva. I generally avoid posterior ptosis repair (MMCR or Fasan...

The key is that all of them have tear film disruption if they have any sort of reasonable 'bleb'. In addition, you don't want to raise the lid too much and expose the bleb and have it dry out, etc. Conservative surgery is the key.

Agree with Dr. @Dr. First Last and would add that the majority of bleb patients I've seen have had long-term medical therapy prior to - and often after - filtration surgery. This means most have significant dry eye disease (caused by the glaucoma meds and preservatives in those meds), which is unive...