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Case Reports
. 2008 Dec;126(12):1759-64.
doi: 10.1001/archophthalmol.2008.508.

Surgical reduction of dysesthetic blebs

Michael Lloyd  1 , Matthew Giegengack, John C Morrison
Affiliations
Case Reports

Surgical reduction of dysesthetic blebs

Michael Lloyd et al. Arch Ophthalmol. 2008 Dec.

Abstract

Dysesthetic blebs can complicate filtration surgery. Lubrication often reduces symptoms; however, some cases require surgical intervention. Limited conjunctivoplasty reduces the symptoms of dysesthetic blebs without sacrificing control of intraocular pressure (IOP). However, this may not sufficiently lower these blebs, particularly if the bleb is thick and dense. We describe a modified conjunctivoplasty technique that includes removal of subconjunctival scar tissue within the interpalpebral fissure and provide a 1-year follow-up of 13 eyes treated in this manner. All patients reported rapid, complete symptom resolution. The IOP was controlled in all 13 eyes following conjunctivoplasty; 3 required topical antiglaucoma therapy. Subconjunctival scar tissue may contribute to the formation of dysesthetic blebs owing to its thickness and by encouraging local dissection of aqueous humor. Our report demonstrates that removal of this tissue does not compromise IOP control when performed with conjunctivoplasty.

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Figures

Figure 1
Figure 1
Surgical drawings (A–D) of steps for bleb reduction. A, Conjunctival mattress sutures to episclera limiting the extent of the bleb. B, Dissection of conjunctiva from underlying connective tissue. C, Excision of subconjunctival connective tissue and repositioning (D) of conjunctiva with buried interrupted sutures. E, Surgical photograph showing the conjunctival dissection with exposure of subconjunctival scar tissue (asterisk).
Figure 2
Figure 2
A, Preoperative photograph of case report patient showing thick vascularized bleb in the nasal interpalpebral space (asterisks) with corneal delle (arrow). B, Close-up showing corneal delle (arrow) with vascularization and thick, elevated bleb extending to limbus (asterisks). C, One-year postoperative photo showing superonasal limit of bleb (arrowheads) with moderate persistence of delle (arrow). D, Close-up postoperative photograph. Comparison to B shows resolution of thick interpalpebral bleb. Delle (arrow) is much improved and no longer vascularized.
Figure 3
Figure 3
A, Preoperative photo of eye 2 showing filtering bleb (arrowheads) extending infernasally into interpalpebral fissure. B, Postoperative photograph at 3 months showing resolution of the inferonasal bleb.
See this image and copyright information in PMC

References

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