Ultrasound biomicroscopy demonstrating etiology of a spontaneous filtering bleb

Khouri, Albert S; Newman, F R; Fechtner, R.D.

doi:10.1038/sj.eye.6702302

Cited by 9 publications

(9 citation statements)

References 4 publications

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“…Scleral thinning occurs in progressive myopia as in the family described by Dagi and Walton [9]. A posterior channel of communication was apparent on UBM between the bleb and ciliary body similar to the findings in a traumatic bleb as described by Khouri et al [2]. …”

Section: Discussionsupporting

confidence: 71%

“…Most conjunctival blebs follow episodes of scleritis [1], accidental penetrating injury or ocular surgical procedures (cataract surgery, scleral fixated intraocular lens implantation, scleral tunnel lensectomy, and cyclophotocoagulation). Spontaneous filtering blebs are rare [2] and have been observed with few systemic disorders (scleroderma [3]), ocular abnormalities (Terrien's marginal degeneration [4] and Axenfeld syndrome [5]), or with systemic conditions, such as familial craniofacial dysmorphism with spontaneous bleb formation [6, 7] known in Lebanon as Traboulsi syndrome. We present the anterior segment imaging and treatment in a case that provides new insights into the pathophysiology of Traboulsi syndrome.…”

Section: Introductionmentioning

confidence: 99%

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Anterior Segment Imaging and Treatment of a Case with Syndrome of Ectopia Lentis, Spontaneous Filtering Blebs, and Craniofacial Dysmorphism

Mansour

Younis

Dakroub

2013

Case Rep Ophthalmol

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Purpose: To report the ultrasound biomicroscopy (UBM) and surgical findings in a subject with a syndrome of ectopia lentis, spontaneous filtering blebs, and craniofacial dysmorphism (Traboulsi syndrome). Methods: Case report, using a 40-MHz UBM wide-field anterior segment scan and anterior segment optical coherence tomography (OCT). Results: A 16-year-old orphan girl presented with visual loss to the level of 6/60 (20/200) bilaterally. She had a central corneal opacification with retrocorneal fibrosis. The anterior chamber was flat with a very poorly dilating pupil. The lens was central in location. Perilimbal conjunctival blebs were bilateral with an intraocular pressure of 8 mm Hg. UBM and anterior segment OCT revealed chronic apposition of the iris to the cornea with angle closure, delineation of the bleb tract and rarefaction of the zonules. The girl had abnormal facial features (a beaked nose and long face) with normal chromosomal studies, negative fluorescent in situ hybridization study for velocardiofacial syndrome and an absence of signs suggesting Marfan syndrome. Under general anesthesia, attempts at deepening the anterior chamber with sodium hyaluronate 3% led to a spontaneous dislocation of the lens into the anterior chamber, facilitating its aspiration. Deepening of the angle was found after lens removal. Retrocorneal fibrosis persisted after surgery, but the bleb height decreased. Best corrected visual acuity did not improve from the preoperative level beyond 6/60 (20/200) because of central retrocorneal fibrosis. Conclusions: Early surgical removal of the lens is necessary in this syndrome to avoid irreversible corneal and trabecular meshwork damage in chronic apposition of the iris to the cornea. UBM can help in the delineation of the bleb tract and document resolution of angle closure after surgery.

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Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Anterior Segment Imaging and Treatment of a Case with Syndrome of Ectopia Lentis, Spontaneous Filtering Blebs, and Craniofacial Dysmorphism

Mansour

Younis

Dakroub

2013

Case Rep Ophthalmol

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“…5 UBM might be helpful in differentiating a filtering bleb from a possible conjunctival cyst. It is also useful for surgical planning if deemed necessary.…”

Section: Commentmentioning

confidence: 99%

UBM study in spontaneous bleb formation and blebitis after cataract surgery in Werner syndrome

Moghimi

Soleimani

Soltani

2009

Eye

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“…Spontaneous filtering blebs are an uncommon entity, the appearance of which may be favored in patients with previous history of penetrating trauma 1 or penetrating ocular procedures, such as cataract surgery or scleral fixated intraocular lens (IOL) implantation. 2 They have also been described in cases without history of trauma or surgery but with ocular thinning abnormalities, such as Terrien’s marginal degeneration, 3 pellucid marginal degeneration, 4 Axenfeld syndrome, 5 scleritis, 6 microspherophakia, 7 systemic disorders like scleroderma, 8 and craniofacial dysmorphism, 9 or other connective tissue diseases with thin sclerae, such as high myopia.…”

Section: Introductionmentioning

confidence: 99%

Unilateral spontaneous filtering bleb dissecting into the cornea in a patient with high myopia

Sanjuán

Salvador-Culla

Canut

et al. 2019

European Journal of Ophthalmology

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Purpose: To report a case of a unilateral spontaneous filtering bleb dissecting into the cornea in a patient with high myopia. Clinical case: A 33-year-old woman with high myopia (–18 D) presented with discomfort in the left eye. Ocular history included pars plana vitrectomy and cataract extraction and posterior chamber intraocular lens implantation in the left eye. Best-corrected visual acuity was 0.65 and intraocular pressure was 20 mmHg. Slit-lamp examination showed a filtering bleb in the upper-temporal quadrant, which extended and dissected the proximal cornea without affecting the visual axis. The morphology and content of the bleb was studied with anterior segment optical coherence tomography, which ruled out a corneal-scleral fistulization into the subconjunctival space. The spontaneous filtering bleb was resected surgically. Due to her high myopia, two strips of fascia lata were used to strengthen the area. In the postoperative period, a complete resection of the bleb was confirmed, without apparent leaking points and with a well-vascularized conjunctiva. No complications were noted. The patient maintained the same best-corrected visual acuity and intraocular pressure than before surgery. Conclusion: The formation of a spontaneous filtering bleb is a rare entity in patients with high myopia, whose risk increases due to their thinned sclerae. The risk is even greater if they have undergone ocular surgeries. Resection of the filtering bleb in our case halted the progression of the corneal dissection, therefore respecting the transparency of the visual axis and preserving visual acuity.

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Ultrasound biomicroscopy demonstrating etiology of a spontaneous filtering bleb

Cited by 9 publications

References 4 publications

Anterior Segment Imaging and Treatment of a Case with Syndrome of Ectopia Lentis, Spontaneous Filtering Blebs, and Craniofacial Dysmorphism

Anterior Segment Imaging and Treatment of a Case with Syndrome of Ectopia Lentis, Spontaneous Filtering Blebs, and Craniofacial Dysmorphism

UBM study in spontaneous bleb formation and blebitis after cataract surgery in Werner syndrome

Unilateral spontaneous filtering bleb dissecting into the cornea in a patient with high myopia

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