Histopathology in a dissecting conjunctival filtering bleb.

Area of Science:

• Ophthalmology
• Surgical Complications
• Glaucoma Surgery

Background:

• Trabeculectomy is a common glaucoma surgery.
• Conjunctival filtering blebs are a typical outcome.
• Late complications can arise years post-surgery.

Observation:

• A patient presented with unilateral tearing four years after trabeculectomy.
• An ipsilateral conjunctival filtering bleb had dissected into the cornea.
• The corneal portion of the bleb was surgically excised for symptom relief.

Findings:

• Histopathology showed the bleb dissected between Bowman's layer and corneal epithelium.
• The bleb's internal portion lacked an epithelial lining.
• This supports a subepithelial dissection plane.

Implications:

• Conjunctival bleb dissection into the cornea is a recognized complication.
• The pathophysiology of this complication is debated.
• Findings suggest blebs can dissect into or overhang the limbal cornea.