Manabe Kaoru, Ikeda Yoshifumi, Fujihara Etsuko, Tanito Masaki
Department of Ophthalmology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane, 693-8501, Japan.
Division of Ophthalmology, Matsue Red Cross Hospital, Matsue, Japan.
J Med Case Rep. 2019 Jul 11;13(1):211. doi: 10.1186/s13256-019-2161-1.
Giant bleb formation after glaucoma tube shunt surgery is a rare condition and consensus regarding its management has not been established.
A 66-year-old Japanese man with primary open-angle glaucoma underwent implantation of an Ahmed glaucoma valve to reduce the intraocular pressure in his left eye. At 4 weeks postoperatively, he presented with a foreign body sensation in his left eye. A slit-lamp examination revealed a giant conjunctival cyst at the superotemporal quadrant and dellen formation at the corneal limbus/conjunctiva adjacent to the anterior border of the giant cyst. Ocular pain was due to a giant bleb that bulged anteriorly from the Ahmed glaucoma valve plate. Eight days after the referral, he underwent surgery to reduce the bleb volume in his left eye. To recess the bleb, the anterior edge of the dissected bleb capsule was sutured using two interrupted 10-0 absorbable sutures back to the sclera to the anterior edge of the Ahmed glaucoma valve plate. Three months postoperatively, there was no bleb around the corneal limbus, but the bleb was present around the plate.
The surgical technique reported here can be an option to relieve dellen-associated ocular pain due to a bleb formed after tube shunt surgery.
青光眼引流管分流术后巨大水泡形成是一种罕见情况，关于其治疗尚未达成共识。
一名66岁的日本原发性开角型青光眼男性患者接受了艾哈迈德青光眼引流阀植入术，以降低其左眼眼压。术后4周，他左眼出现异物感。裂隙灯检查发现颞上象限有一个巨大的结膜囊肿，在巨大囊肿前缘相邻的角膜缘/结膜处有角膜小凹形成。眼痛是由于一个从艾哈迈德青光眼引流阀板向前突出的巨大水泡所致。转诊8天后，他接受了左眼减少水泡体积的手术。为了使水泡退缩，将切开的水泡囊前缘用两根10-0间断可吸收缝线缝合回巩膜至艾哈迈德青光眼引流阀板的前缘。术后3个月，角膜缘周围没有水泡，但引流阀板周围有水泡。
本文报道的手术技术可作为缓解引流管分流术后形成的水泡所致角膜小凹相关眼痛的一种选择。
