- More frequently developed following full-thickness filtration surgery
or an antiproliferative-enhanced trabeculectomy.
- Complications commonly associated with full thickness filtration
procedures are formation of an exuberant bleb due to a lack of aqueous
flow resistance, over-filtration with resultant early hypotony, shallow
anterior chamber, cataract, corneal decompensation and choroidal detachment.
- Complications associated with antiproliferative application include
corneoscleral, ciliary body and vitreoretinal toxicity, conjunctival
wound leak, bleb rupture, and progression of cataract.
- Vision loss due to hypotony or hypotonic maculopathy, although rare,
is more likely associated with the use of mitomycin-C.
- Management:
- Thorough evaluation of the bleb post-operatively to assess
potential filter failure, conjunctival leak, infection and other
complications.
- Large soft contact lenses (18 - 22 mm) have been reported to
be helpful in the management of leaking blebs.
- Rigid glaucoma shell is also useful in managing friable conjunctival
tissues with multiple holes.
- Excision of the conjunctival tissue or subconjunctival fibrosis,
cryotherapy, argon laser, or revision surgery may be needed to
improve the filtration bleb.
|
