Application of handheld cautery for reduction of symptomatic circumferential trabeculectomy blebs.

PURPOSE

To describe a new, in-office procedure for limiting symptomatic, circumferential conjunctival blebs occurring after trabeculectomy.

PATIENTS

Two eyes of 2 patients status postfornix-based trabeculectomy with mitomycin C were found to have symptomatic circumferential blebs.

METHODS

Risks and benefits of cautery were discussed, along with alternatives including continued conservative treatment or surgical revision. The patients opted for in-office cautery. Two eyes of 2 patients underwent cauterization of their blebs with a Bovie high temperature handheld cautery in the office after topical pretreatment with 2.5% neosynephrine and 4% xylocaine. Excess fluid was drained from the bleb by expression through the puncture wounds. The wounds were Seidel negative immediately after the treatment.

RESULTS

Flattening of the bleb occurred instantly, patients did not experience pain and their symptoms related to the extensive bleb resolved. The functioning of the bleb was not altered in these 2 cases by this procedure.

CONCLUSIONS

Early results show that handheld cautery may be a useful means of treating symptomatic circumferential blebs.