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Editors Selection IGR 12-3

Surgery: Exuberant blebs

Comment by Robert Feldman on:

26379 Application of handheld cautery for reduction of symptomatic circumferential trabeculectomy blebs, Schwartz AL; Albano M, Journal of Glaucoma, 2010; 19: 497-498

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This report by Schwartz and Albano (1467) of two cases of a method to revise exuberant symptomatic blebs which extend into the interpalpebral fissure adds to the numerous methods already reported. These types of procedures are generally effective as long as the problem is not at the level of the main loculation of the filtration bleb. Using cautery makes sense in that it shrinks the elevated tissue and creates enough inflammation to scar it down where needed. The advantages of this procedure are in its simplicity, low cost and ease to perform. This method was originally presented by Palmberg in 2005. Theoretically, a line of cautery may be as effective as a grid over the entire elevated area because it will not allow fluid to pass distally once scarred down. Another simple in-office method (bleb window pexy) based on the same concepts involves cutting a window in the area where the bleb needs to be lowered and scarred down and either applying light cryotherapy to invoke inflammation or applying tissue glue to create a seal and induce adequate inflammation for scarring to sclera. The problem with all of these procedures is that often the bleb will find a way around the area treated, although generally patients remain asymptomatic. It is always useful to add another method to our armamentarium. However, this procedure has been in use for at least five years and it would be helpful to see results from more than two patients.

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