Lanzl I M, Katz L J, Shindler R L, Spaeth G L
Department of Ophthalmology, Technische Universität München, Germany.
J Glaucoma. 1999 Aug;8(4):247-9.
Large filtering blebs that evolve after trabeculectomies can be bothersome to the patient, especially when overhanging the cornea. Partial bleb excision is warranted to relieve the patient from discomfort or even visual impairment.
Surgical partial excision of the overhanging corneal part of the bleb was performed in four patients who had undergone earlier trabeculectomy without application of antimetabolites. Duration of follow-up after excision ranged from 9 months to 4 years.
Successful reduction of the excessive bleb and continued satisfactory control of intraocular pressure (IOP) were achieved in all four cases. Partial excision of the corneal part of the bleb did not lead to bleb leakage in any of the cases.
Surgical blunt dissection of the overhanging the morphologic features of the bleb and ensuring continued control of IOP and relief of symptoms. Alternative methods, such as autologous blood injection, cryoapplication, application of trichloracetic acid, or application of Nd:YAG laser, are noninvasive but do not allow precise rearrangement of bleb architecture.
小梁切除术后形成的大滤过泡可能会给患者带来困扰，尤其是当滤过泡悬垂于角膜表面时。部分滤过泡切除术有助于缓解患者的不适，甚至避免视力损害。
对4例早期接受小梁切除术且未使用抗代谢药物的患者，手术切除悬垂于角膜表面的滤过泡部分。切除术后的随访时间为9个月至4年。
4例患者均成功减少了过大的滤过泡，并持续满意地控制了眼压（IOP）。滤过泡角膜部分的部分切除术在所有病例中均未导致滤过泡渗漏。
手术钝性分离悬垂的滤过泡部分可重塑滤过泡的形态特征，并确保持续控制眼压和缓解症状。其他方法，如自体血注射、冷冻治疗、三氯乙酸应用或钕：钇铝石榴石激光应用，虽为非侵入性，但无法精确重塑滤过泡结构。
