Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India.
Glaucoma Service, Department of Paediatric Ophthalmology, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India.
Indian J Ophthalmol. 2022 Apr;70(4):1438. doi: 10.4103/ijo.IJO_628_22.
Trabeculectomy is associated with several complications. One of the common complications with mitomycin assisted trabeculectomy is thin cystic bleb leading to bleb leak, hypotony and infections. Various technique of bleb repair and reconstruction have been described, such as conjunctival advancement, or scleral, pericardial or corneal patch graft.
To demonstrate bleb revision by bleborhexis and clear corneal lamellar patch graft for a patient with thin cystic leaking bleb leading to hypotony and decreased vision.
This was a 75-year-old one-eyed lady, diagnosed with primary angle-closure glaucoma in both eyes with absent light perception in the left eye, had undergone a combined trabeculectomy and cataract surgery in the right eye 6 years ago. She presented with diminution of vision (6/18p), introacular pressure (IOP) of of 6 mmHg, thin cystic leaking overhanging bleb, and dysesthesia. Bleb repair by bleborhexis with lamellar corneal patch graft was performed. Bleborhexis is a technique in which the overhanging fibrosed thin cystic conjunctival bleb is peeled off the cornea smoothly to leave a uniform clear corneal surface. Clear cornea, uniform diffuse bleb, well-formed anterior chamber with and IOP of 15 mmHg was noted on the first post-operative day, with a vision of 6/12p. This procedure helped meticulous reconstruction of the bleb, early recovery of vision, maintanance of normotensive eye, and save the eye from potential infections.
Bleborhexis with lamellar corneal patch graft provides for an easy and a elegant surgical technique with minimal corneal tissue damage, faster healing and patient comfort. It could be the favored technique in patients with thin overhanging clebs.
小梁切除术伴有多种并发症。丝裂霉素辅助小梁切除术后常见的并发症之一是薄的囊性隆起导致滤泡渗漏、眼压降低和感染。已经描述了各种滤泡修复和重建技术，例如结膜推进术、巩膜、心包或角膜贴片移植。
通过滤泡切开术和透明角膜板层贴片移植修复因薄的囊性渗漏滤泡导致眼压降低和视力下降的患者的滤泡。
这是一位 75 岁的单眼女性，双眼患有原发性闭角型青光眼，左眼无光感，6 年前右眼接受了小梁切除术和白内障手术。她出现视力下降（6/18p）、眼内压（IOP）为 6mmHg、薄的囊性渗漏滤泡、感觉异常。通过滤泡切开术和板层角膜贴片移植进行滤泡修复。滤泡切开术是一种技术，其中将悬垂的纤维化薄囊性结膜滤泡从角膜上平滑剥离，留下均匀的透明角膜表面。在术后第一天，注意到透明角膜、均匀弥漫性滤泡、前房形成良好，眼压为 15mmHg，视力为 6/12p。该手术有助于对滤泡进行精细重建，使视力及早恢复，维持正常眼压，并防止眼睛受到潜在感染。
滤泡切开术联合板层角膜贴片移植提供了一种简单而优雅的手术技术，对角膜组织损伤最小，愈合更快，患者舒适度更高。对于薄的悬垂滤泡患者，它可能是首选技术。
