Institut Clínic d'Oftalmologia - Hospital Clínic i Provincial de Barcelona, Barcelona, Spain.
Institut de la Mácula, Barcelona, Spain.
Acta Clin Croat. 2023 Aug;62(2):378-381. doi: 10.20471/acc.2023.62.02.18.
A late postoperative trabeculectomy complication could be the overhanging bleb, especially when antimetabolites are used. It can be associated with hypotony, foreign body sensation, dellen, and visual compromise. We report a case of an avascular overhanging bleb successfully reduced with a modified sutureless technique. Nine years before, our patient had trabeculectomy using mitomycin C. After the surgery, the intraocular pressure was correct, without progression in the visual field, but on slit-lamp examination, a large avascular overhanging bleb was noted. Partial excision was performed with dissection from the cornea, overhanging conjunctival trimming, leakage checking and Bandage Contact lens placement. Topical antibiotic and steroid treatment was administered for three weeks. The excised conjunctival histopathology showed avascular metaplastic epithelium. Six months after the surgery, the patient's visual acuity improved, with intraocular pressure of 12 mm Hg and a Seidel negative asymptomatic bleb. In conclusion, this less invasive technique preserves better bleb function without ripping the surrounding ischemic tissue. The procedure is safe and easy to perform, with less surgical time and fast recovery.
术后晚期滤过泡并发症可能是滤过泡突出，尤其是在使用抗代谢药物时。它可能与眼压降低、异物感、凹陷和视力受损有关。我们报告了一例使用改良无缝线技术成功缩小无血管滤过泡突出的病例。九年前，我们的患者曾接受过丝裂霉素 C 小梁切除术。手术后，眼压正常，视野无进展，但在裂隙灯检查时，发现一个大的无血管滤过泡突出。从角膜开始进行部分切除，切除突出的结膜，检查渗漏并放置绷带接触镜。局部应用抗生素和类固醇治疗持续了三周。切除的结膜组织病理学显示无血管性化生上皮。手术后 6 个月，患者视力提高，眼压为 12mmHg，滤过泡无 Seidel 阴性症状。总之，这种侵袭性较小的技术可以在不撕裂周围缺血组织的情况下更好地保留滤过泡功能。该手术安全且易于操作，手术时间短，恢复快。
