Filtering bleb modification with a THC:YAG (Holmium) laser
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Published on: May 23, 2025
Andrew G Iwach1, Maria E Delgado, Misato Adachi
1Glaucoma Research & Education Group, San Francisco, California 94102, USA.
Objective:
To present a method for remodeling oversized blebs using the THC:YAG laser and describe its use in treating hypotony and bleb leaks.
Methods:
Retrospective medical record review of 13 patients who underwent holmium laser bleb revision.
Results:
Thirteen eyes of 13 patients were analyzed. All the patients had an oversized bleb and 2 patients presented an associated late-onset leaking bleb. Mean preoperative IOP was 4.1 mm Hg. THC:YAG laser energy was applied to the bleb to remodel and/or close the leak. After a mean follow up of 17.3 months, the mean IOP was 7.84 mm Hg +/- 2.3. Postsurgery complications included hyphema and the inadvertent rupture of a conjunctival microcyst. Visual acuity improved in 9 of the eyes and remained stable in 4 of the eyes.
Conclusion:
The THC:YAG laser can be used effectively to sculpt large blebs, reduce symptoms associated with large blebs, increase IOP in hypotonous eyes, and under specific circumstances, close bleb leaks.
