Outcomes of surgical reduction of dysesthetic bleb

Session Details

Session Title: Glaucoma II

Session Date/Time: Monday 15/09/2014 | 08:00-10:30

Paper Time: 09:45

Venue: Boulevard F (Level 1)

First Author: : A.Dyrda SPAIN

Co Author(s): :    M. Pazos              

Abstract Details

Purpose:

To present results of bleb dysesthesia reduction which is a rare complication of glaucoma surgery and is understood as ocular discomfort caused by circumferential bleb.

Setting:

Department of Ophthalmology, Hospital de la Esperanza, PSMAR, Barcelona

Methods:

We present three cases of surgically reduced dysesthetic blebs using conjunctivoplasty and its modification described by Anis (Arch Ophthalmol 2006) and Lloyd ( Arch Ophthalmol 2008) , respectively. This technique consists of the following steps: 1) conjuntival, radial incision to the bare sclera in the desired limit of the bleb, 2) suturing with buried, interrupted sutures the nearest edge of the filtering bled, 3) lower perilimbic peritomy including unwanted area of the extended bleb, 4) dissection and removal of the underlying episcleral tissue, 5) conjunctival and absorbable sutures.

Results:

Circumferential blebs developed after 9.7±4.7 months from primary filtration procedure (trabeculectomy with mitomycin C) in two patients of 68 and 72 years. Surgical reduction was decided in three eyes after failure of medical treatment. In all cases, a rapid disappearance of symptoms with very good aesthetic and functional outcome was observed. After 6 months follow-up patients remain asymptomatic and maintain intraocular pressure (IOP) 10.7 ± 1.2 mmHg without treatment.

Conclusions:

Modified bleb-limiting conjunctivoplasty is the method of choice in dysesthetsia when intensive topical lubrication fails. Also, it is possible to decide intraoperatively which mechanisms, avascular or fibrous, predominate, and choose the most appropriate procedure, bleb reduction with or without excision of subconjunctival tissue. This technique provides dysesthesia relief while maintaining bleb’s function.

Financial Interest:

NONE