Lens & Cataract-Inadvertent Subconjunctival Bleb

Inadvertent filtering bleb seen in a patient undergone cataract extraction surgery more than 10 years ago.

Wound leak under sealed overlying conjunctiva.
May occur, particularly following cataract surgery using limbal or scleral incision techniques complicated with wound dehiscence.
Clinical features:
- Symptoms:
  - May be asymptomatic
  - Tearing due to wound leaking
  - Decreased vision
- Signs:
  - Subconjunctival microcysts or bleb
  - Wound gape
  - Seidel test (+)
  - Hypotony
  - Corneal folds
  - Shallow anterior chamber
May be complicated by hyphema, endophthalmitis, choroidal effusion, choroidal folds or papilledema.
Management:
- No treatment necessary if asymptomatic and no further risks or complications observed.
- Surgical repair by wound resuturing or bleb excision may be considered in cases with:
  - Large, cystic thin-walled bleb
  - Persistent hypotony
  - Poor tissue apposition
  - Iris prolapse
  - Astigmatism

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