Surgical management for refractory bleb dysesthesia
Author
Dyrda, Agnieszka
Antón López, Alfonso
Figueroa-Vercellino, Juan Pablo
Pazos, Marta
Publication date
2020-08ISSN
2090-004X
Abstract
Purpose. To present long-term results of modified bleb-limiting conjunctivoplasty as a successful treatment for intractable bleb dysesthesia and to review the literature on the surgical management of dysesthetic bleb. Methods. Consecutive case series and literature review. We present four cases of surgically reduced painful blebs. Our technique consisted of the following steps: (1) conjunctival, radial incision to the bare sclera in the desired limit of the bleb; (2) suturing with buried, interrupted sutures at the nearest edge of the filtering bleb; (3) lower limbal peritomy including unwanted area of the extended bleb; (4) dissection and removal of the underlying fibrous tissue when present; (5) conjunctival and resorbable sutures. In addition, a systematic literature review was performed. Only reports presenting outcomes of surgical treatment of bleb dysesthesia after filtering procedure were included in review. Results. Four eyes were included consecutively in the study in a period of 4 years. On average, they developed circumferential bleb dysesthesia 9.3 ± 4.7 months after uneventful combined phacotrabeculectomy with Mitomycin C as primary procedure. Surgical reduction was decided after failure of lubricants in controlling ocular discomfort. Two cases showed a dense fibrous tissue beneath the conjunctiva that was excised to ensure filtration. In all cases, a rapid disappearance of symptoms with very good aesthetic and functional outcome was observed. After 12-month follow-up, patients remained asymptomatic and maintained intraocular pressure of 10.7 ± 1.2 mmHg without treatment. A systematic review of the literature obtained 15 eligible case series (n = 123) with rates of success within 46–100%, favoring less aggressive approaches to reduce bleb size. Conclusion. Bleb dysesthesia is a rare complication of filtering glaucoma surgery. This modified bleb-limiting conjunctivoplasty technique (with removal of subjacent fibrous tissue if present) is able to target the underlying etiology providing ocular discomfort relief while maintaining bleb function and may be considered as first-choice surgical treatment.
Document Type
Article
Document version
Published version
Language
English
Subject (CDU)
61 - Medical sciences
617 - Surgery. Orthopaedics. Ophthalmology
Keywords
Ulls--Cirurgia
Oftalmologia
Hemorràgia
Glaucoma
Ojos -- Cirugía
Oftalmología
Hemorragia
Glaucoma
Surgery -- Eyes
Ophthalmology
Bleeding
Glaucoma
Pages
7
Publisher
Hindawi
Collection
2020;
Is part of
Journal of Ophthalmology
Citation
Dyrda, Agnieszka; Anton López, Alfonso; Figueroa-Vercellino, Juan Pablo [et al.]. Surgical management for refractory bleb dysesthesia. Journal of Ophthalmology, 2020, 2020, p. 1-7. Disponible en: <https://www.hindawi.com/journals/joph/2020/7570454/>. Fecha de acceso: 27 oct. 2020. DOI: 10.1155/2020/7570454.
This item appears in the following Collection(s)
- Ciències de la Salut [736]
Rights
© 2020 Agnieszka Dyrda et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Except where otherwise noted, this item's license is described as https://creativecommons.org/licenses/by/4.0/