Sequential management of chronic leaking bleb

Abstract

Aim: To report the sequential management of late leaking filtering bleb that spontaneously occurred following trabeculectomy with mitomycin C or following trauma. Patients and methods: Seven eyes of 7 patients with late bleb leak who developed hypotony between January 2001 and June 2004 were included in this retrospective, non-comparative, interventional case series. Sequential management consisted of therapeutic contact lens, cyanoacrylate glue with overlying soft contact lens, dye-enhanced laser photocoagulation, horizontal purse-string compression suture, and bleb revision with transposition conjunctival graft. Results: Preoperative intraocular pressure ranged from 0 to 5 mm Hg. The leakage site was successfully closed in all 7 eyes. Five eyes were successfully treated with compression sutures, 1 with cyanoacrylate glue, and 1 with bleb revision using a transposition flap from the surrounding conjunctiva. The final intraocular pressure ranged from 10 to 18 mm Hg. Four eyes gained at least 2 Snellen lines of visual acuity, 1 improved from hand movement to 20/400, 1 had stabilised vision, and 1 had decreased visual outcome. Conclusion: Sequential management ranging from non-invasive measures to compression suture and surgical revision with conjunctival graft was effective for closing most late bleb leaks and preserving some visual function, although intraocular pressure control was compromised.