Finger prick autologous bleb (FAB) to treat oozing avascular trabeculectomy bleb: pilot study

Session Details

Session Title: Presented Poster Session: Ocular Pathologies

Venue: Poster Village: Pod 3

First Author: : C.Gizzi UK

Co Author(s): :    S. Balal   R. Nitiahpapand   G. Nithyanandarajah   A. Scott   A. Sharma           

Abstract Details

Purpose:

Avascular blebs following trabeculectomy are more common with the use of antimetabolites such as 5-fluorouracil (5-FU) and mitomycin C (MMC). Avascular blebs are often associated with transconjunctival ooze and are at greater risk of complications such as: hypotony, hypotony maculopathy, choroidal detachment and bleb-related infections. There is no standard treatment for avascular oozing blebs, although topical autologous serum has shown preliminary positive results. The aim of this case study is to investigate the effect of fingerprick autologous blood (FAB) as an alternative to serum (Than et al , RCOphth. guidelines 2017) for the treatment of an avascular oozing bleb.

Setting:

Moorfields Eye Clinic at Bedford Hospital, Bedford, UK

Methods:

a patient with an avascular oozing trabeculectomy bleb was enrolled in the study, after informed consent. The patient was instructed on the FAB technique: after washing hands and wiping a fingertip with an alcohol street, patient was asked to use a lancet to draw a drop of blood from the fingertip and to apply the drop to the inferior conjunctival fornix. The procedure was repeated 4 times a day for 2 weeks. Photographs of the bleb after the application of 1 drop of 2% fluoresceine were taken at baseline and after 3 days.

Results:

the patient had trabeculectomy with MMC done in the right eye in 2008. At baseline his right visual acuity was 6/5 with glasses and his right intraocular pressure (IOP) was 5 mmHg. No hypotony related complications were noted. The bleb showed oozing at inspection with 2% fluoresceine. Following 3 days of treatment with FAB technique, the amount of staining and oozing of the bleb significantly decreased, as clearly shown by anterior segment photographs. At 2 weeks follow-up the right visual acuity was stable, right IOP was 6 mmHg and the bleb wall maintained its improved appearance. No complications were observed.

Conclusions:

although this is a single case study we observed a significant improvement in the permeability of the avascular bleb with 2% fluoresceine test after only 3 days of treatment with FAB. The improvement was maintained at 2 weeks follow-up. No subjective or objectives side effects were reported. FAB seems to be a promising, minimally invasive and cost effective technique to reduce the permeability of avascular oozing blebs. This treatment might also reduce the risks of complications associated with this type of blebs, such as hypotony and bleb-related infections.

Financial Disclosure:

None