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Editors Selection IGR 22-2

Filtering Blebs: Managing dysesthesia in large blebs

Comment by Shan Lin on:

24505 "Bleb window"-pexy for the management of symptomatic, oversized blebs, Tabet R; Feldman RM; Bell NP et al., Journal of Glaucoma, 2009; 18: 546-551

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Tabet et al. (1318) have described a sutureless, non-laser technique for managing dysethesia associated with large blebs. This procedure is a modification of a prior technique reported by the authors in which a conjunctiva/Tenons window is created and cryotherapy is applied (bleb window cryopexy [BWC]). In the updated method, called bleb window-pexy (BWP), fibrin tissue glue (Tisseel) application to the bare sclera replaces cryotherapy, and the eye is left unpatched. Although this case series had a limited number of treated eyes (six) and mean follow-up period (six months), the favorable results suggest this procedure may be an immediately effective alternative for painful, oversized blebs. All of the patients experienced immediate improvement in symptoms up to the last follow up. The authors reported no significant complications. In particular, there were no cases of bleb leak observed and mean intraocular pressure was not significantly different (IOP). However, it is not possible from this small, retrospective case series to assess the relative safety and efficacy of this procedure as compared to other described techniques such as chemical irritants and laser treatment of the bleb. In addition, longer follow up of a larger group will allow for a better assessment of the long-term efficacy and effect on IOP. In the present study, the IOP was mildly to moderately higher in 4 out of the 6 eyes at last follow up than at baseline.

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