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Year : 2020  |  Volume : 58  |  Issue : 2  |  Page : 129

Late-Onset bleb leak after trabeculectomy with mitomycin-C


Department of Glaucoma, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India

Date of Submission24-Feb-2020
Date of Decision06-Apr-2020
Date of Acceptance21-Apr-2020
Date of Web Publication17-Jun-2020

Correspondence Address:
Dr. Vijayalakshmi A Senthilkumar
Department of Glaucoma, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_11_20

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How to cite this article:
Senthilkumar VA. Late-Onset bleb leak after trabeculectomy with mitomycin-C. TNOA J Ophthalmic Sci Res 2020;58:129

How to cite this URL:
Senthilkumar VA. Late-Onset bleb leak after trabeculectomy with mitomycin-C. TNOA J Ophthalmic Sci Res [serial online] 2020 [cited 2020 Jul 13];58:129. Available from: http://www.tnoajosr.com/text.asp?2020/58/2/129/286924



A 65-year-old male, known case of primary open angle glaucoma who underwent trabeculectomy (Trab) with mitomycin-C (MMC) and intraocular lens implantation in the right eye (RE) 2 years back, presented to us with defective vision for the past 3 months. His best-corrected visual acuity and intraocular pressures in the RE were 20/200 and 4 mmHg. Slit lamp examination of the RE revealed a thin-walled avascular diffuse bleb with Siedel's positive near the limbus, suggestive of bleb leak, shallow anterior chamber, and pseudophakia [Figure 1]. Fundus evaluation of the RE showed a glaucomatous cupping with hypotonous maculopathy. The patient underwent bleb revision with conjunctival advancement surgery. The Seidel test is named after the German ophthalmologist Erich Seidel (1882–1948). Late bleb leak is a recognized complication of Trab with antifibrotics that may occur months or years after initial surgery. Frequency of late bleb leaks ranges from 1.8% to 10% and potential complications are blebitis and endophthalmitis.[1],[2] As bleb leaks can lead to complications of varying severity, their effective management is paramount to the success of filtering surgery, as well as to the maintenance of ocular health and vision.[3],[4]
Figure 1: (a) Slit lamp photograph diffuse illumination RE showing thin-walled avascular diffuse bleb with shallow anterior chamber and pseudophakia. (b) Slit lamp photograph with cobalt blue filter showing large area of bleb leak near the limbus with Siedel's test positive

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Suñer IJ, Greenfield DS, Miller MP, Nicolela MT, Palmberg PF. Hypotony maculopathy after filtering surgery with mitomycin C. Incidence and treatment. Ophthalmology 1997;104:207-14.  Back to cited text no. 1
    
2.
Phillips WB 2nd, Wong TP, Bergren RL, Friedberg MA, Benson WE. Late onset endophthalmitis associated with filtering blebs. Ophthalmic Surg 1994;25:88-91.  Back to cited text no. 2
    
3.
Belyea DA, Dan JA, Stamper RL, Lieberman MF, Spencer WH. Late onset of sequential multifocal bleb leaks after glaucoma filtration surgery with 5-fluorouracil and mitomycin C. Am J Ophthalmol 1997;124:40-5.  Back to cited text no. 3
    
4.
Liebmann JM, Sokol J, Ritch R. Management of chronic hypotony after glaucoma filtration surgery. J Glaucoma 1996;5:210-20.  Back to cited text no. 4
    


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