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• W1982498259 abstract "Sir, Large overhanging blebs are uncommon complications of filtering surgeries for glaucoma, about 2% as a late complication (Ticho & Ophir 1993; Scheie & Guehl 1979). In eyes with large, overhanging and functional blebs, surgical excision, cryotherapy or laser therapy would be the primary choice of treatment (Scheie & Guehl 1979; Douvas 1972). However, in the case with large overhinging but non-functional blebs, no literature on the treatment for a such a situation has been published. Herein, we will describe a patient who needed sugical management of the large, overhinging but non-functional bleb. A 75-year-old man with primary open angle glaucoma was examined at our institution. Corrected visual acuity in the right eye was 20/300. His intraocular pressure of the right eye was uncontrollable despite maximal medication and he underwent mitomycin C-augmented trabeculectomy. One year later, he developed vitreous hemorrhage due to central retinal vein occlusion in the right eye and underwent surgical treatment with vitrectomy. At 2 years after the vitreous surgery, he developed a nuclear cataract. The filtering bleb had extended to the upper one-third of the cornea (Fig. 1; top), after which he complained of decreased visual acuity in the right eye. He underwent phacoemulsification with temporal approach, but rupture of the posterior capsule occurred. Preoperative and postoperative visual acuity was light perception and 20/400, respectively. After cataract surgery, the bleb gradually became fibrous and larger, overlapping the upper half of the cornea, blocking the pupillary region. At 8 months after cataract surgery, he complained about acute visual loss of the right eye. Also, his right eye developed iridial rubeosis and elevation in the intraocular pressure. We were unable to examine the ocular fundus due to the fibrotic overhanging bleb. In the right eye, visual acuity was light perception and the intraocular pressure was 32 mm Hg. (Top) Photograph of the large overhanging and functional bleb prior to fibrotic change. (Bottom) The fibrotic nonfunctional bleb was excised and the bleb was easily reflected from the cornea. Corneal epithelial defect is shown and white arrows indicate the lower border. In order to manage intraocular pressure and ocular fundus, surgical removal and reconstruction of the bleb was conducted as described below. After excision of the conjunctival and episcleral scar, the overhanging fibrotic bleb was removed (Fig. 1; bottom). As previously reported (Scheie & Guehl 1979), the bleb lies only in contact with the corneal surface. Intraoperative observation showed that the bleb was filled with white fibrous tissue (Fig. 2; top). For reconstruction of filtering route, the free conjunctival graft obtained from the lower nasal limbus was sutured with 10–0 nylon as described previously (Fig. 2; bottom) (Wilson & Kotas-Neumann 1994). Postoperatively, laser treatments were applied on the ischemic retina. During the follow-up periods up to 41 months, a small bleb was maintained and the intraocular pressure was well controlled. Visual acuity of the right eye at 41 months after surgery was 20/300. (Top) Dissection of the bleb showed the bleb was filled with white fibrous tissue. (Bottom) The prepared conjunctival autograft was sutured onto the cornea and conjunctiva with 10–0 nylon. The technique described here for managing a large non-functional bleb that overlaps the cornea was effective and postoperative result was good. As described previously (Honjo et al. 1998), we regard trabeculectomy on a cicatricial conjunctiva as a useful and safe surgical treatment even for refractory glaucoma. Taken together, the removal of large, overhanging but non-functional blebs and reconstruction with free conjunctival autograft should be considered as an alternative choice of surgical treatments. Corresponding author: Hidenobu TaniharaDepartment of OphthalmologyTenri Hospital, Mishima-cho 200Tenri, 632-0015, JapanTel: 011 81 7436 3 5611Fax: 011 81 7436 2 1903e-mail: tanihara@pearl. ocn.ne.jp Received on October 2nd, 2000. Accepted on November 30th, 2000." @default.
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• W1982498259 date "2001-06-01" @default.
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• W1982498259 title "Removal of a large non-functional bleb and reconstruction with free conjunctival autograft after trabeculectomy" @default.
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• W1982498259 doi "https://doi.org/10.1034/j.1600-0420.2001.790326.x" @default.
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