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Foreign body granulomas secondary to retained sponge fragment following mitomycin C trabeculectomy
Sami Al-Shahwan1, Deepak P Edward
1King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
Background:
Bleb related inflammation following trabeculectomy is usually seen in the late post operative period and is unusual in the first 6 months after surgery We report the clinical findings and course of two patients with early bleb related inflammation secondary to retained cellulose sponge fragments used to apply mitomycin C on the scleral surface.
Methods:
Retrospective review of medical records of two patients and pathology from one patient.
Results:
Both patients developed bleb related inflammation four months after a combined fornix based trabeculectomy and cataract procedure in which mitomycin C was applied using filter paper discs (Whatman filter paper #1). Material suggestive of cellulose fragments was noted in the filtering bleb in both patients. Patient 1 had a bleb leak at time of presentation and pathologic examination of foreign body material obtained from the site of the leak demonstrated a granulomatous reaction surrounding cellulose fibers. The foreign body material was removed in both patients. This led to resolution of the bleb leak in the first patient and at one year following the procedure both patients had functioning blebs in the affected eye.
Conclusions:
Retention of sponge fragments is rare but may be a cause of bleb inflammation as a result of a foreign body granulomatous reaction. The choice of sponge material that does not shred may help in avoiding this unusual complication.
Insights
Early bleb inflammation after glaucoma surgery can occur due to retained cellulose sponge fragments. Removal of these fragments resolved inflammation and restored bleb function in two patients.
Area of Science:
- Ophthalmology
- Glaucoma Surgery
- Ocular Inflammation
Background:
- Bleb related inflammation typically occurs late after trabeculectomy.
- Early onset inflammation within 6 months is unusual.
Observation:
- Two patients experienced early bleb inflammation four months post-trabeculectomy and cataract surgery.
- Mitomycin C was applied using cellulose filter paper discs.
- Cellulose fragments were found within the filtering bleb.
Findings:
- One patient presented with a bleb leak.
- Pathology revealed a granulomatous reaction to cellulose fibers.
- Surgical removal of fragments resolved bleb leaks and inflammation.
- Both patients maintained functioning blebs at one year.
Implications:
- Retained sponge fragments are a rare cause of bleb inflammation via foreign body reaction.
- Using non-shredding sponge materials may prevent this complication.