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

Ng, Danny Siu-Chun; Ching, Ruby Hok-Ying; Yam, Jason C.; Chan, Clement W N

doi:10.3341/kjo.2013.27.2.145

Cited by 6 publications

(4 citation statements)

References 14 publications

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“…The initial management of bleb dysaesthesia involves lubricants. Autologous blood and compression sutures have been described in the treatment of over‐filtrating, leaking and overhanging blebs . We report outcomes including patient satisfaction for symptomatic relief from bleb dysaesthesia that did not improve with the use of lubricants.…”

Section: Resultsmentioning

confidence: 99%

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Bleb compression and autologous blood for relief of bleb dysaesthesia. Does it work?

Begum

Bobat

Kirwan

2016

Clinical Exper Ophthalmology

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Section: Resultsmentioning

confidence: 99%

“…The use of this approach has been well described, and is reported to reduce bleb size and height . To this, we have added simple patient satisfaction data.…”

Section: Resultsmentioning

confidence: 99%

Bleb compression and autologous blood for relief of bleb dysaesthesia. Does it work?

Begum

Bobat

Kirwan

2016

Clinical Exper Ophthalmology

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“…Several factors, such as gravity on the OHB, the action of the eyelid, scar hyperplasia, and excessive aqueous over-filtration, may contribute to the formation of OHBs [ 14 , 15 ]. Different therapeutic methods (dissection, neodymium YAG laser, and autologous blood injection and compression suture) have been used to deal with these problems [ 14 , 16 , 17 , 18 ]. Following TLE, patients with OHB sometimes complain about vision change and dysesthesia, dry eye, and excessive tearing [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Influence of Overhanging Bleb on Corneal Higher-Order Aberrations after Trabeculectomy

Mizuno

Hirooka

Kiuchi

2021

JCM

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Recent advances in ocular aberrometry have revealed that ocular surgery increases ocular and corneal higher-order aberrations. This retrospective single-center study aimed to examine the effects of the overhanging bleb on corneal higher-order aberrations using a wavefront analyzer. We included 61 eyes from 50 patients with overhanging bleb after trabeculectomy with a fornix-based conjunctival flap using mitomycin C (overhanging bleb group) and 65 eyes from 54 glaucoma patients with no history of glaucoma surgery (control group). Corneal higher-order aberrations (total higher-order aberrations, coma aberrations, coma-like aberrations, spherical aberrations, and spherical-like aberrations) on a 4 mm pupil diameter were measured using the TOPCON KR-1W wavefront analyzer. Corneal coma aberrations were higher in the overhanging bleb group than in the control group (0.16 ± 0.13 μm and 0.10 ± 0.05 μm, respectively; p = 0.042). Corneal coma-like aberrations were also higher in the overhanging bleb group than in the control group (0.31 ± 0.32 μm and 0.16 ± 0.09 μm, respectively; p = 0.022). With an increasing ratio of cornea covered by the bleb to the entire cornea, all corneal higher-order aberrations increased except for corneal coma-like aberrations. Overhanging bleb after trabeculectomy with a fornix-based conjunctival flap using mitomycin C and its size influenced corneal higher-order aberrations.

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“…We would also recommend to rather fashion a scleral tunnel from the temporal side than from superior as it has been shown to reduce the SIA significantly and improve access to the anterior segment. 3 Dr Li did not state how the SIA was calculated, and we would suggest using vector analysis described by Dr Alpins. 4 We recommend not doing a surgical peripheral iridectomy from the scleral tunnel as access to the iris is not optimal from superior because of the configuration of the scleral tunnel.…”

Section: Scleral Tunnel Intraocular Lens Explantation: Commentmentioning

confidence: 99%

Scleral tunnel intraocular lens explantation: comment

2016

Clinical Exper Ophthalmology

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Scleral tunnel intraocular lens explantation: comment I read with interest the case series by van Zyl et al. where intraocular lense (IOL) explantation was achieved via sutureless long scleral tunnels fashioned as in manual small incision cataract surgery (MSICS). 1 I recently travelled overseas to learn MSICS. Upon my return to Australia, two cases of subluxated IOLs presented and I utilised scleral tunnelling for IOL explantation.Patient 1 had a sudden IOL dislocation 25 years after original cataract surgery. A three-piece IOL was found in the anterior vitreous and the capsular bag was not identifiable. A scleral tunnel was fashioned superiorly, and an anterior chamber (AC) entry was initially limited to one pass of the keratome to facilitate anterior vitrectomy and anteriorisation of the IOL while maintaining AC stability. After applying acetylcholine, the scleral tunnel was widened to facilitate IOL removal and permit implantation of an AC IOL. However, surgical peripheral iridectomy (PI) was difficult due to the length of the scleral tunnel and caused significant iris trauma. The resulting vitreous haemorrhage caused delayed visual rehabilitation. Upon clearance of the vitreous haemorrhage 3 months later, the patient saw 6/7.5 with À0.25 D DS. Surgically induced corneal astigmatism was 1.31 D.Patient 2 had cataract surgery more than 20 years ago complicated by PC rupture and retinal detachment necessitating pars plana vitrectomy. He received a sclera-fixated poly(methyl methacrylate) one-piece IOL 13 years ago, but one of the sutures broke causing subluxation. A neodymium-doped yttrium aluminium garnet laser PI was performed preoperatively. A scleral tunnel was fashioned, and anteriorisation of the IOL was successful after removing the other remaining suture. After removal of the IOL from the scleral tunnel, an AC IOL was implanted without surgical PI. Visual rehabilitation was rapid, and after 6 weeks, the patient achieved 6/9 with +0.5 D DS. Surgically induced astigmatism was 1.30 D.I agree with van Zyl et al. that IOL explantation via deep scleral tunnels provides several advantages over clear corneal incisions. Cutting or folding IOLs in the AC inherently possesses significant risk of injury to the endothelium, capsular bag and iris. Large rigid IOLs that cannot be cleaved intracamerally, such as in Patient 2 aforementioned, would require very large corneal incisions to remove, which means unstable ACs for long periods of time while suturing is being completed. The risks of vitreous loss, retinal detachment, suprachoroidal haemorrhage and endophthalmitis are increased while suturing with an unstable AC, and the amount of induced corneal astigmatism from such large wound would be considerable. The scleral tunnel allows removal of large IOLs without the need to cleave or fold them intracamerally, a more stable AC throughout the surgery and decreased operating time and corneal astigmatism because suturing is unnecessary.I found two practical points helpful. Firstly, after fashioning a scleral tunnel wide ...

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

Cited by 6 publications

References 14 publications

Bleb compression and autologous blood for relief of bleb dysaesthesia. Does it work?

Bleb compression and autologous blood for relief of bleb dysaesthesia. Does it work?

Influence of Overhanging Bleb on Corneal Higher-Order Aberrations after Trabeculectomy

Scleral tunnel intraocular lens explantation: comment

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