Risk Factors for a Severe Bleb Leak Following Trabeculectomy: A Retrospective Case-Control Study.

PURPOSE: To describe the population at risk of having a severe bleb leak needing a surgical repair in the operating room and to study risk factors associated with severe bleb leak. PATIENTS AND METHODS: In this case-control study, 17 cases were enrolled and paired with 51 controls. We studied all patients having a surgical revision in our center for a severe bleb leak between January 1 and December 31, 2008. Three controls were paired to each case based on their surgery date. We then analyzed risk factors related to the patient, the intervention, and the postoperative follow-up. RESULTS: Younger age was the only statistically significant risk factor for a severe bleb leak in our study. The odds of a severe bleb leak decreased as the age increased (P=0.0029). In comparing the risk for a severe bleb leak in younger (below 55 y) versus patients aged 75 years or older, the odds ratio was 21.0. There were no statistically significant differences between cases and controls with respect to: type of glaucoma, number or types of previous ocular surgeries, number of preoperative topical medications, localization of the leak, localization of the wound (fornix or limbus-based), or the intraocular pressure on day 1 postoperative. CONCLUSIONS: Younger age at the time of trabeculectomy may be a risk factor for severe bleb leak. A trend was observed in which the patients under the age of 55 years were at greater risk for a severe bleb leak.

Childhood Mucous Membrane Pemphigoid: A Case With Exclusively Ocular Involvement.

PURPOSE: To report a case of mucous membrane pemphigoid (MMP) occurring in childhood with exclusively ocular involvement. METHODS: Case report. RESULTS: A 12-year-old girl presented with mild bilateral conjunctival cicatrization, symblepharon, and peripheral inflammatory keratitis. No other mucosal or cutaneous involvement was present. The findings of an initial conjunctival biopsy with immunofluorescence study were negative for MMP. After a few recurrences of mild corneal and conjunctival inflammation, a second conjunctival biopsy was performed at a different site in the same eye, 30 months later. Only then was the diagnosis of MMP confirmed using positive direct immunofluorescence. The results of a systemic investigation for autoimmune vasculitis were negative. Therapy with dapsone was introduced, and a good response was obtained. CONCLUSIONS: MMP is an extremely rare condition in children. This case is the second one reported with exclusively ocular involvement. Despite its rarity in the pediatric age group, MMP should be considered in the differential diagnosis of chronic conjunctival inflammation and fibrosis. Furthermore, a single negative biopsy should not exclude this diagnosis in a suspected clinical case, even in children. When a high degree of suspicion is present, a repeat biopsy may prove useful.