Clinical evaluation of intra-bleb pigmentation after trabeculectomy: a case-control study.

OBJECTIVE: To evaluate the clinical status of a filtering bleb with visible pigment (intra-bleb pigmentation, IBP), in a case-controlled manner. MATERIAL AND METHOD: Forty-one patients with IBP and 40 patients without visible pigment in blebs (controls) were enrolled from the authors' clinic. All patients underwent either trabeculectomy alone or combined cataract extraction with intraocular lens implantation and trabeculectomy. RESULTS: Mean follow-up period was 22.8 months. Complete success (final IOP < 22 mmHg without additional treatment) was achieved more often in IBP patients (82.9%) than in controls (60%, p = 0.022). Median survival time was greater in IBP patients (49.9 +/- 0 months) than in controls (35.5 +/- 4.9 months, p = 0.013). Regression analysis revealed that IBP was associated with thin and cystic blebs (p = 0.023). Sex, age, eye, diagnosis, procedure, and mitomycin C had no effect on IBP development. IBP grading, location, and appearance did not relate to the success rate or bleb characteristics. CONCLUSION: IBP appears to be a favorable sign in filtering blebs, in terms of complete success and survival time, because IBP is associated with thin-walled blebs. Clinicians should carefully observe patients for IBP when evaluating filtering blebs.

Intra-bleb pigmentation after trabeculectomy.

PURPOSE: To report the presence of intra-bleb pigmentation (IBP), appearing after trabeculectomy and combined clear cornea phacoemulsification, intraocular lens (IOL) implantation and trabeculectomy (combined surgery). METHOD: Ten eyes of 8 Asian patients with IBP were studied. Four eyes underwent trabeculectomy for uncontrolled glaucoma, and 6 eyes underwent combined surgery for cataract coexisting with glaucoma. Seven of the 10 eyes had adjunctive mitomycin C for the procedures. RESULTS: Mean follow-up time was 11.6 months (range 3-15 months). Five of the 10 eyes had intra-operative and post-operative complications requiring intraocular manipulation (ruptured posterior capsule and in-the-sulcus IOL, flat anterior chamber, malignant glaucoma, iris prolapse). Blebs were thin (8 eyes), or with moderate thickening of conjunctiva (2 eyes) with IBP either overlying the scleral flap or spread beneath the conjunctiva. IBP initially appeared at 2 to 44 weeks after the procedures. Nine of the 10 eyes (90%) had IOPs < or = 22 mmHg without medication. CONCLUSION: IBP is associated with iris trauma at surgery and dispersal of pigment into the bleb, where it spreads or proliferates. A thin bleb provides a clear view of IBP as well as functional filtration. IBP appears to be a favorable sign of the filtration.