Complications: Focus on the Bleb

A 46-year-old myopic white male developed severe hypotony maculopathy with a visual acuity of 8/200 and an IOP of 3 mm Hg 2 weeks after combined phacoemulsification and trabeculectomy with mitomycin C for juvenile glaucoma. Despite success with surgical revision of the bleb in cases of posttrabeculectomy hypotony maculopathy,1-3 we were aware that reopening the conjunctival flap still posed a risk that the bleb might fail.4 Shirato et al5 described a simpler technique involving tightly resuturing the scleral flap directly through the conjunctiva with one or two sutures of 10–0 nylon on a round, tapered needle at the slit lamp or under an operating microscope. Some leakage occurred postoperatively at the sutured points, but it resolved spontaneously a few hours or days later. The suture was spontaneously buried in the conjunctiva in 1 week. The lack of a persistent bleb leak was attributed to closure of the scleral flap and a reduction in outflow. In a case series of 56 eyes Hypotony due to an Overactive Bleb