Recurrence of gigantic overhanging bleb post excision: a case report.

GMS ophthalmology cases Pub Date : 2023-09-19 eCollection Date: 2023-01-01 DOI:10.3205/oc000224
Kirti Singh, Mainak Bhattacharyya, Ravinder Saran, Nikhil Gotmare, Himshikha Aggarwal, Pragya Jain
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Abstract

Purpose: To report the case of an extremely large overhanging bleb, extending from superior fornix to limbus, in a 57-year-old poorly controlled diabetic, six years after trabeculectomy for an uncontrolled primary open angle glaucoma (POAG) with recurrence, months after complete excision.

Methods: An overhanging bleb is defined as a filtering cicatrix which has been massaged downward over the cornea by eyelid action. It has been linked to anti-metabolite use during glaucoma filtering surgery. Despite being functional, these blebs result in patient discomfort ranging from foreign body sensation and lacrimation to dysphotopsia. A 57-year-old male presented with complaints of reduced vision, foreign body sensation, watering, and difficulty in eye closure in the left eye (OS) for past 6 months. He had undergone trabeculectomy with mitomycin C 6 years ago for advanced primary open-angle glaucoma with no follow-up beyond the initial one 4 weeks post-surgery.

Results: At presentation, he had a giant multi-loculated, cystic filtering bleb (15 mm x 8 mm x 4-5 mm), which was carefully excised. Amniotic membrane was used as an anti-fibrotic as well to cover the defect. Seven months after surgery, there was recurrence of this overhanging cystic bleb when it was again excised with debulking of the conjunctiva done and cryotherapy applied to its margins.

Conclusion: Although multiloculated cystic overhanging blebs have been documented before, such a large (posterior extent till fornix), thick-walled multiloculated bleb with histopathological evidence of chronic inflammatory process has not been reported prior.

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巨大悬泡切除后复发1例报告。
目的:报告一例57岁的糖尿病患者,在小梁切除术后6年,从上穹窿延伸到角膜缘的巨大悬泡,该患者在完全切除后数月,因未控制的原发性开角型青光眼(POAG)复发而进行小梁切除。方法:悬泡是指通过眼睑动作向下按摩角膜的滤过性瘢痕。它与青光眼滤过手术中使用抗代谢产物有关。尽管这些气泡具有功能性,但会导致患者不适,从异物感、流泪到吞咽困难。一名57岁男性在过去6个月内出现视力下降、异物感、流泪和左眼(OS)闭眼困难的症状。6年前,他因晚期原发性开角型青光眼接受了丝裂霉素C小梁切除术,术后4周没有随访。结果:他出现了一个巨大的多室囊性滤过泡(15 mm x 8 mm x 4-5 mm),被小心切除。羊膜也被用作抗纤维化的材料来覆盖缺损。手术后7个月,当再次切除结膜并对其边缘进行冷冻治疗时,这种悬垂的囊泡复发。结论:尽管以前已经记录过多房囊性悬突泡,但以前从未报道过如此大(后部至穹窿)、厚壁的多房泡具有慢性炎症过程的组织病理学证据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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