Role of oral doxycycline and large diameter bandage contact lens in the management of early post-trabeculectomy bleb leak

Abstract

A 27-year-old man with juvenile open angle glaucoma and medically uncontrolled intraocular pressure (IOP) underwent a trabeculectomy with mitomycin C in his right eye. One week postoperatively, he developed ischaemic necrosis of the conjunctiva with a bleb leak. This was managed conservatively with oral doxycycline 100 mg twice daily along with a topical low-dose steroid, antibiotic and cycloplegic and a large diameter bandage contact lens (BCL). There was dramatic improvement in the bleb appearance, the necrosis healed and the leak resolved. The patient had well-controlled IOP with a diffuse healthy bleb at 4 weeks, which was maintained at 2 years. This case illustrates the utility and importance of oral doxycycline in the management of early post-trabeculectomy conjunctival necrosis and the use of BCL in the management of a bleb leak. This safe and non-invasive method not only hastened the recovery but also helped in maintaining good bleb function.

Figure 1

Slit-lamp photograph showing conjunctival necrosis, 1 week post-trabeculectomy.

Figure 2

Slit-lamp photograph showing improvement in conjunctival necrosis, 3 days after starting oral doxycycline.

Figure 3

Slit-lamp photograph showing a healthy bleb, 4 weeks postoperatively.

Figure 4

Slit-lamp photograph showing a diffusely elevated bleb, 2 years postoperatively.