Korean J Ophthalmol.  2013 Apr;27(2):145-148. 10.3341/kjo.2013.27.2.145.

Safe Excision of a Large Overhanging Cystic Bleb Following Autologous Blood Injection and Compression Suture

• Ng DS
• Ching RH
• Yam JC
• Chan CW

• KMID: 1503810
• DOI: http://doi.org/10.3341/kjo.2013.27.2.145

Abstract

Here, we report a large, overhanging cystic bleb that compromised vision and induced a foreign body sensation in a patient who underwent a trabeculectomy surgery with anti-metabolite therapy 4 years prior. Ultrasound biomicroscopy revealed multiple loculations with thin septa inside the bleb and a high risk of damage to the bleb was anticipated with a straight forward surgical excision. We injected autologous blood and placed a compression suture 6 weeks prior to surgical excision of the overhanging portion of the bleb. The operation was successful in preserving excellent bleb function, restoring visual acuity, and alleviating symptoms in our patient with up to 9 months of follow-up.

Keyword

Antimetabolites; Blood; Sutures; Trabeculectomy

MeSH Terms

Blister/pathology/*surgery
Blood Transfusion, Autologous/*methods
Conjunctiva/pathology/surgery
Glaucoma/*surgery
Humans
Male
Middle Aged
Postoperative Complications/*surgery
*Suture Techniques
Trabeculectomy/*adverse effects

Figure

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  Fig. 1 A large, right eye overhanging cystic bleb is clearly visible without lifting the patient's upper lid.

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  Fig. 2 Ultrasound biomicroscopy of the overhanging cystic bleb revealed multiple loculations within the bleb. Septa were formed between loculations, which may be friable due to previous anti-metabolite therapy.

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  Fig. 3 One week after injection of autologous blood into the overhanging portion of the cystic bleb and placement of compression suture.

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  Fig. 4 Three months after excision of the overhanging portion of the cystic bleb. The size of the bleb was much reduced and was visible only after lifting the upper lid.

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