RESUMO
Background: Trabeculectomy is associated with several complications. One of the common complications with mitomycin assisted trabeculectomy is thin cystic bleb leading to bleb leak, hypotony and infections. Various technique of bleb repair and reconstruction have been described, such as conjunctival advancement, or scleral, pericardial or corneal patch graft. Purpose: To demonstrate bleb revision by bleborhexis and clear corneal lamellar patch graft for a patient with thin cystic leaking bleb leading to hypotony and decreased vision. Synopsis: This was a 75-year-old one-eyed lady, diagnosed with primary angle-closure glaucoma in both eyes with absent light perception in the left eye, had undergone a combined trabeculectomy and cataract surgery in the right eye 6 years ago. She presented with diminution of vision (6/18p), introacular pressure (IOP) of of 6 mmHg, thin cystic leaking overhanging bleb, and dysesthesia. Bleb repair by bleborhexis with lamellar corneal patch graft was performed. Bleborhexis is a technique in which the overhanging fibrosed thin cystic conjunctival bleb is peeled off the cornea smoothly to leave a uniform clear corneal surface. Clear cornea, uniform diffuse bleb, well-formed anterior chamber with and IOP of 15 mmHg was noted on the first post-operative day, with a vision of 6/12p. This procedure helped meticulous reconstruction of the bleb, early recovery of vision, maintanance of normotensive eye, and save the eye from potential infections. Highlights: Bleborhexis with lamellar corneal patch graft provides for an easy and a elegant surgical technique with minimal corneal tissue damage, faster healing and patient comfort. It could be the favored technique in patients with thin overhanging clebs.
RESUMO
PURPOSE: To report a case of fibrotic obstruction of scleral orifice in Ex-PRESS shunt. CASE SUMMARY: A 57-year-old male presented with elevated intraocular pressure in his left eye. In the past, laser photocoagulation was performed at a local clinic due to retinal venous occlusion in his left eye. During observation, he was transferred to our hospital due to uncontrolled intraocular pressure despite antiglaucoma medications. He was diagnosed with neovascular glaucoma in the left eye. Since intravitreal injection of anti-vascular endothelial growth factor with maximal medical therapy did not lower the intraocular pressure, an Ex-PRESS shunt device was implanted. Two weeks postoperatively, the bleb was flat and diffuse with shallow anterior chamber and intraocular pressure was below 5 mm Hg. Therefore, we performed scleral flap revision and intraocular pressure was sustained between 10 and 15 mm Hg. Two months postoperatively, the patient experienced high intraocular pressure and no elevated bleb, thus we performed bleb revision. During the surgery, although we removed fibrotic adhesions between the conjunctiva and episclera using a 30-gauge needle, aqueous outflow was not observed. Therefore, we opened the scleral flap and found the scleral orifice of the Ex-PRESS shunt was obstructed by fibrous scar tissue. After scar tissue removal and achieving aqueous outflow through the scleral opening, intraocular pressure decreased to a satisfactory level. CONCLUSIONS: In patients with elevated intraocular pressure after implantation of the Ex-PRESS shunt, the scleral opening of the Ex-PRESS shunt should be examined for obstruction.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Câmara Anterior , Vesícula , Cicatriz , Túnica Conjuntiva , Fatores de Crescimento Endotelial , Glaucoma Neovascular , Pressão Intraocular , Injeções Intravítreas , Fotocoagulação , Agulhas , RetinaldeídoRESUMO
La trabeculectomía es uno de los tratamientos de elección en los pacientes con glaucoma. La causa más común de fallo de esta cirugía en su primer trimestre es la bula de filtración encapsulada. Usualmente es resultado de la proliferación fibrótica subconjuntival que lleva a fallo de la bula, como por ejemplo en los glaucomas traumáticos. La revisión con agujas y la mitomicina C constituyen una opción efectiva y relativamente segura para restaurar la función de la cirugía de filtración. Se presenta un paciente donde se restableció el flujo de humor acuso con este proceder
Trabeculectomy is the surgical treatment of choice for many patients with glaucoma. The most common cause of failure during the first trimester after trabeculectomy is encapsulated bleb. Generally, that results from scarring in the subconjunctival space with a resultant intrableb fibrosis and the development of a failed bleb, for example in traumatic glaucoma. Needling bleb revision with mitomycin-C appears to be an effective and relatively safe way to revive the function of the filtration surgery. This was the case report of a patient whose aqueous humor flow was reestablished with this treatment
RESUMO
Trabeculectomy, as a surgical intervention in the treatment of glaucoma, has become most popular. The most common cause of filtration failure is obstruction of aqueous outflow due to bleb fibrosis. Adjunctive intraoperative mitomycin-C has been reported to improve the success of filtration surgery in eyes of high risk for failure. But its use increases the rate of complications after filtering surgery: especially postoperative hypotony, wound leakage, and scleral necrosis. We have experienced two patients whose scleral flaps were necrotized after trabeculectomy with mitomycin-C in uncomplicated glaucoma. We report successful results in revision of filtering bleb by using Gore-Tex as a patch graft.