Analysis of Autologous Blood Injection for Late-onset Filtering Bleb Leak after Trabeculectomy

PURPOSE: To evaluate the effect of autologous blood injections for late-onset filtering bleb leakage after trabeculectomy METHODS: Retrospective chart review was done on 15 patients 16 eyes that had autologous blood injection(s) for filtering bleb leak occurring later than 2 months after trabeculectomy at the Masan Samsung Hospital. Successful treatment was defined as resolution of the bleb leak and no need for additional glaucoma medications. Failure was defined as a persistent bleb leak, intraocular pressure greater than 21 mm Hg, or the occurrence of a vision-threatening event related to the procedure. RESULTS: The mean age of the patients was 53.9 years old (38~74 years). Ten eyes were men (62.5%) and 6 were women (37.5%). Sixteen eyes of 15 patients had autologous blood injection for filtering bleb leak and were followed for a mean of 12.7 months (SD, 5.8; range, 3 to 25 months). Eleven eyes (68.7%) were classified as failures because of persistence of the leak. Five eyes (31.3%) had an initially successful outcome, but the success rate decreased over time as bleb leaks recurred in one of the five eyes at 3 month. Mean intraocular pressure increased from 4.9mmHg at pretreatment to 7.6 mmHg at final examination (P<0.05). Snellen visual acuity (with correction or pinhole) remained within 2 lines of pretreatment acuity in 12 eyes (75%). Blood seepage into the anterior chamber after autologous blood injection was the common complication, but it was transient. CONCLUSIONS: Although it showed limited success, autologous blood injection for late-onset bleb leak may be considered as a supportive measure before preforming invasive incisional surgery.

A Case of Recurrent Valsalva Retinopathy Associated with Exercising a Barbell

PURPOSE: To report one case of recurrent Valsalva retinopathy presented as subretinal hemorrhage associated with exercising a barbell in a healthy man. METHODS: A 47-year-old healthy man visited our hospital complaining of a pericentral blind-spot in the right visual field. At first visit, visual acuity was 20/20 without correction. Anterior segment examination was unremarkable and dilated fundus examination revealed a subretinal hemorrhage in the inferior area of the macula. We followed up the visual acuity, anterior segment exam, fundus examination, and fluorescein angiography for several weeks. RESULTS: Three weeks after the first visit, the size of subretinal hemorrhage decreased, but recurrent subretinal hemorrhage presented after exercising a barbell at the existing hemorrhagic part and its inferior area. Six weeks after the recurrent hemorrhage, the hemorrhage was resolved completely and the pericentral blind-spot was recovered. CONCLUSIONS: Valsalva hemorrhagic retinopathy is characterised by retinal hemorrhage occurring in healthy individuals due to a rapid rise in intrathoracic or intra-abdominal pressure. In this case, there was recurrent subretinal hemorrhage after repeatedly exercising a barbell. So, it is very important to educate patients about the restriction of excessive Valsalva maneuver to prevent recurrent Valsalva retinopathy.