Surgical Management for Refractory Bleb Dysesthesia

Dyrda, Agnieszka; Antón, Alfonso; Figueroa-Vercellino, J.P.; Pazos, Marta

doi:10.1155/2020/7570454

Cited by 5 publications

(8 citation statements)

References 22 publications

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“…This complication is associated with nasal filtering bleb, giant filtering bleb, BMOC, etc. [3,11,12]. OFB and CIFB are both associated with bleb dysesthesia.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological features of corneal invasion by filtering bleb

et al. 2023

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Purpose To describe the clinicopathological characteristics and explore the possible etiology of cornea invasion by filtering bleb (CIFB) after filtering surgery. Methods We reviewed 22 patients treated for CIFB between March 2005 and March 2022. The patients were followed up for more than 1 year. Slit-lamp examination, optical coherence tomography (OCT), ultrasound biomicroscopy, and histopathological examination were performed to observe the morphology of the bleb and depth of corneal invasion. Depending on the severity of the lesion, treatments consisting of local massage, acupuncture separation, or surgical resection were administered. Results The mean age of the patients was 56.3 ± 8.8 years. All patients underwent filtering surgery in the moderate or advanced stage of glaucoma. The filtering bleb was closely connected with the cornea, and its posterior boundary was locally adhered. Forward displacement of the internal opening of the filtering bleb was found in 4 of 7 surgically treated patients. OCT and pathological examination showed that the filtering blebs invaded the corneal stroma. Removal of the adhesion of the posterior boundary of the filtering bleb by different treatment methods successfully improved the patients’ conditions. Conclusion Filtering blebs can invade the corneal stroma. Adhesion of the posterior boundary and forward displacement of the internal opening of the filtering bleb are the possible causes of CIFB. Removal of the adhesion of the posterior boundary of the filtering bleb can halt the progression of CIFB.

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“…This complication is associated with nasal filtering bleb, giant filtering bleb, BMOC, etc. [3,11,12]. OFB and CIFB are both associated with bleb dysesthesia.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological features of corneal invasion by filtering bleb

et al. 2023

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“…This complication is associated with nasal ltering bleb, giant ltering bleb, BMOC, etc. [3,14,15]. OFB and CIFB are both associated with bleb dysesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…OFB and CIFB are both associated with bleb dysesthesia. While nasal ltering bleb and giant ltering bleb have been extensively studied, our understanding of BMOC remains insu cient [3,14]. Almost all cases of BMOC reported thus far have involved OFBs or giant ltering blebs.…”

Section: Discussionmentioning

confidence: 99%

“…This type of bleb needs to be distinguished from giant ltering blebs, which are usually well-functioning, but cause discomfort to the patient by interrupting the tear lm distribution over the bleb and cornea. Giant ltering blebs can cross the limbus and cover the cornea [3,14,15]. The etiology of giant ltering blebs is similar to that of CIFB.…”

Section: Discussionmentioning

confidence: 99%

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Clinicopathological features of corneal invasion by filtering bleb

Shi

Zhou

Chen

et al. 2022

Preprint

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Purpose: : To describe the clinicopathological characteristics and explore the possible etiology of cornea invasion by filtering bleb (CIFB) after filtering surgery. Methods: We reviewed 22 patients treated for CIFB between March 2005 and March 2022. The patients were followed up for more than 1 year. Slit-lamp examination, optical coherence tomography (OCT), ultrasound biomicroscopy, and histopathological examination were performed to observe the morphology of the bleb and depth of corneal invasion. Depending on the severity of the lesion, treatments consisting of local massage, acupuncture separation, or surgical resection were administered. Results: The mean age of the patients was 56.3 ± 8.8 years. All patients underwent filtering surgery in the moderate or advanced stage of glaucoma. The filtering bleb was closely connected with the cornea, and its posterior boundary was locally adhered. Forward displacement of the internal opening of the filtering bleb was found in 4 of 7 surgically treated patients. OCT and pathological examination showed that the filtering blebs invaded the corneal stroma. Removal of the adhesion of the posterior boundary of the filtering bleb by different treatment methods successfully improved the patients’ conditions. Conclusion: Filtering blebs can invade the corneal stroma. Adhesion of the posterior boundary and forward displacement of the internal opening of the filtering bleb are the possible causes of CIFB. Removal of the adhesion of the posterior boundary of the filtering bleb can halt the progression of CIFB.

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“…Mean duration of follow-up was 20.3 months and there was no significant difference between the two groups with respect to complete or qualified success, although bleb de-epithelialization was associated with the need for fewer glaucoma medications. Dyrda et al 40 reported long-term results of a modified bleb-limiting conjunctivoplasty as a treatment for bleb dysesthesia in a consecutive case series of four patients with painful blebs. After 12 months, patients remained asymptomatic and maintained an average IOP of 10.7 mmHg without treatment.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of bleb revision with ologen following filtering glaucoma surgery

Kornmann

Fellman

Smith

et al. 2021

European Journal of Ophthalmology

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Purpose This study reports long-term outcomes of bleb revision with ologen™ Collagen Matrix (Aeon Astron Europe BV, the Netherlands) for the surgical management of various bleb-related issues including persistent bleb leaks with or without associated hypotony, bleb dysesthesia, overhanging blebs, or hypotony after filtering glaucoma surgery. Materials and methods A retrospective chart review was performed for patients who underwent ologen bleb revision from 2012 to 2019 at Glaucoma Associates of Texas. Results The study included 23 eyes of 22 patients undergoing bleb revision with the ologen implant. Mean age was 74.0 ± 11.3 years, 16 (69.6%) were female, and 13 (56.5%) were White. Indications for bleb revision included bleb leak (78.3%), dysesthesia (13.0%), and hypotony from an overfiltering bleb (8.7%). Mean preoperative intraocular pressure was 6.8 ± 4.1 mmHg and the number of medications was 0.3 ± 0.9. Median follow-up was 24 months (range: 12–84 months); all patients had at least 12 months of follow-up. At 1 year, mean intraocular pressure was 10.9 ± 4.6 mmHg on 0.2 ± 0.5 medications, and at last follow-up, mean intraocular pressure was 10.4 ± 3.6 mmHg on 0.3 ± 0.7 medications. Bleb morphology remained low, diffuse, and posterior. One patient developed kissing choroidal effusions requiring surgical drainage with subsequent stabilization of intraocular pressure and bleb function, and three patients required additional surgery due to persistent leaks or bleb failure; there were no other vision-threatening complications. Conclusions Use of the ologen implant during surgical bleb revision is a useful surgical technique that confers long-term improvements in bleb morphology and stability of function.

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Surgical Management for Refractory Bleb Dysesthesia

Cited by 5 publications

References 22 publications

Clinicopathological features of corneal invasion by filtering bleb

Clinicopathological features of corneal invasion by filtering bleb

Clinicopathological features of corneal invasion by filtering bleb

Outcomes of bleb revision with ologen following filtering glaucoma surgery

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