Escape tardío de la bula de filtración a propósito de un caso / Late onset of leaking filtering bleb in a case

Paciente masculino de 48 años, de color de la piel mestizo, al que se le realizó trabeculectomía con antimetabolito en su ojo derecho con daño glaucomatoso avanzado y atrofia óptica glaucomatosa en su ojo izquierdo. Tres años después acude a consulta de seguimiento con escape tardío de la ampolla de filtración, perforación escleral y ligera hipotonía ocular. Surge la disyuntiva entre realizar recubrimiento de la ampolla con trasplante conjuntival autólogo, con el riesgo de elevación posterior de la presión intraocular por encima de su valor meta, y no practicar tratamiento quirúrgico con elevada posibilidad de endoftalmitis. Se realizó el proceder y en el seguimiento se constató un injerto conjuntival bien adaptado y vascularizado, con presión intraocular inferior a 15 mmHg en cada consulta y no progresión del daño glaucomatoso

The case of a 48 years-old male patient was presented. He underwent trabeculectomy with antimetabolites to treat advanced glaucomatous damage in his right eye and optical glaucomatous atrophy in his left eye. After three years, he went to the follow-up medical service with late-onset of leaking filtering bleb, sclera perforation and slight ocular hypotony. The dilemma of covering the bleb with conjunctival autologous graft, with the risk of raised intraocular pressure over the target value o non-performance of the surgical treatment with high possibility of endophthalmitis was present. It was decided to apply the surgical procedure. The follow-up showed a well-adapted and vascularized conjunctival graft and intraocular pressure lower than 15 mm Hg in each medical appointment, without advance in glaucomatous damage

Management of complications in glaucoma surgery.

Surgical option for glaucoma is considered when other modalities are not working out to keep the intraocular pressure under control. Since the surgical procedures for glaucoma disrupt the integrity of the globe, they are known to produce various complications. Some of those complications can be vision-threatening. To minimize the morbidity, it is very important that one should know how to prevent them, recognize them and treat them. The objective of this article is to provide insight into some of those complications that will help the ophthalmologists in treating glaucoma patients in their clinical practice.