Complications of inadvertent filtering blebs after cataract extraction

Johnson, Sandra Marchese; Pike, Evan C.; Feinstein, Eric

doi:10.1016/j.jcrs.2011.12.016

Cited by 3 publications

(8 citation statements)

References 20 publications

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“…An inadvertent bleb after uneventful cataract surgery, without an association with MMC, is also rare [ 4 ]. There have been only a few reports of these complications ranging from 2 years to over 10 years after cataract extractions [ 4 , 6 ]. The underlying cause was from internal wound gape observed from gonioscopy [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

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Inadvertent filtering bleb due to extracapsular cataract extraction wound reopening after mitomycin C use: a case report

2023

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Background Mitomycin C has been used adjunctively in various procedures, including pterygium excision. Delayed wound healing, the long-term complication of mitomycin C, can occur several years later and may rarely cause a subsequent inadvertent filtering bleb. However, conjunctival bleb formation from the reopening of an adjacent surgical wound after mitomycin C use has not been reported. Case presentation A 91-year-old Thai woman had undergone pterygium excision 26 years ago, with adjunctive mitomycin C, as well as an uneventful extracapsular cataract extraction in the same year. The patient developed a filtering bleb without glaucoma surgery or trauma approximately 25 years later. Anterior segment ocular coherence tomography illustrated a fistula connected between the bleb and anterior chamber at the scleral spur. The bleb was observed without further management, as no hypotony or bleb-related complications occurred. The symptoms/signs of bleb-related infection were advised. Conclusions This is a case report of a rare novel complication of mitomycin C application. Conjunctival bleb formation from the reopening of surgical wound, which was related to the previous mitomycin C use, could occur after a few decades.

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Section: Discussionmentioning

confidence: 99%

“…In terms of treatment, as the fibrotic bleb, in this case, was nonfunctional and there was no bleb-related complication, excision of the bleb may not be required [ 4 ]. However, late bleb leaks in this patient are still possible due to the complication of MMC [ 2 – 6 ].…”

Section: Discussionmentioning

confidence: 99%

Inadvertent filtering bleb due to extracapsular cataract extraction wound reopening after mitomycin C use: a case report

2023

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“…Wound dehiscence and subsequent bleb formation is a well-known complication of cataract surgeries with scleral tunnel approach, whether sutured or not. 5–8 On the other hand, post-traumatic wound dehiscence are rare, and less expected, in view of the tight apposition aimed for during the primary repair. Rarely, when open globe injury is left untreated, 3 or if unfortunate repeat trauma occurs, 1,9–11 then their chance increases.…”

Section: Discussionmentioning

confidence: 99%

The high-pressure bleb

Selvan

Lakra

Yadav

et al. 2021

European Journal of Ophthalmology

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A 45-year-old male presented with a slowly progressive, painless swelling in his right eye for the past 6 months. He had undergone an open globe injury repair 10 years back and an eventful cataract surgery 5 years back. The presenting visual acuity in the affected eye was perception of light with inaccurate projection of rays. The intraocular pressure was 44 mm Hg with advanced glaucomatous cupping. The swelling was identified to be a communicating sub-tenon cyst secondary to scleral wound dehiscence from secondary angle closure glaucoma. Wound re-suturing, cyst excision and diode laser cyclophotocoagulation was performed in a single sitting, with explained poor visual prognosis.

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“…Therefore, wound dehiscence occurs when the radial stress forces exceed the tensile strength of the wound or if disruption of the collagenous lamellae reduces the tensile strength. Common pathophysiologic mechanisms include trauma, suture malfunction, scleral melt, obesity, old age and prolonged steroid use [ 1 , 11 ]. Delayed wound dehiscence can occur due to abnormal collagen structure in systemic disorders, such as in Marfan syndrome [ 12 ] and diabetes [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Inadvertent filtering blebs have been reported following cataract surgery [ 1 ] and secondary to corneal wick syndrome [ 2 ] and pterygium surgery [ 3 ]. Complications include hypotony, macular oedema, shallow anterior chamber, choroidal detachment, dellen formation and blebitis that can progress to sight-threatening endophthalmitis [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Late-Onset Inadvertent Bleb Formation following Pars Plana M3 Molteno Implant Tube Obstruction

Abdul-Rahman

Molteno

2017

Case Rep Ophthalmol

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Purpose: To report a case of inadvertent bleb formation presenting 18 months after pars plana M3 Molteno implant tube obstruction in a patient with mixed mechanism glaucoma. Materials and Methods: An 84-year-old Caucasian male with mixed mechanism glaucoma underwent slit-lamp examination, gonioscopy, colour anterior segment photography and anterior segment optical coherence tomography (AS-OCT). Results: An inadvertent bleb developed 18 months after pars plana implant tube re-positioning with a 6/0 Vicryl tie ligature. The bleb was located in the area anterior to the implant plate; it was characterised by a thin, transparent, avascular and multi-cystic wall, with a visible stoma at the posterior edge of the bleb. The bleb was functioning as demonstrated by an intraocular pressure of 6 mm Hg at presentation and a punctate fluorescein uptake pattern of the bleb wall. The bleb over the plate of the Molteno implant was non-functioning, likely secondary to tube obstruction by vitreous in the early postoperative period. AS-OCT showed a tract from the anterior chamber commencing at an entry wound through a corneal tunnel to the posterior stoma at the base of the inadvertent bleb. Conclusions: We hypothesise that the pathophysiologic factors resulting in an inadvertent bleb are a result of a combination of apoptosis, late-onset wound dehiscence and internal gaping of a centrally placed corneal wound. In addition, aqueous hydrodynamic factors may play a role.

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Complications of inadvertent filtering blebs after cataract extraction

Abstract: No author has a financial or proprietary interest in any material or method mentioned.

Cited by 3 publications

References 20 publications

Inadvertent filtering bleb due to extracapsular cataract extraction wound reopening after mitomycin C use: a case report

Inadvertent filtering bleb due to extracapsular cataract extraction wound reopening after mitomycin C use: a case report

The high-pressure bleb

Late-Onset Inadvertent Bleb Formation following Pars Plana M3 Molteno Implant Tube Obstruction

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