"Bleb window"-pexy for the management of symptomatic, oversized blebs

To describe a simple method and outcomes of remodeling dysesthetic, oversized filtering blebs.

Retrospective chart review of the initial consecutive patients who had undergone "bleb window"-pexy (BWP) over a 1-year period. Patients with symptomatic, oversized, and dysmorphic blebs that did not show signs of spontaneous resolution were candidates for the technique, regardless of the intraocular pressure. Under topical anesthesia, a conjunctival window was created in the filtering bleb at the palpebral fissure (nasal or temporal) using Westcott scissors. The cut edges of conjunctiva and Tenon capsule were then glued to the underlying bare sclera using autologous fibrin tissue glue. In the case of extended (360 degrees) blebs (2 patients), 2 conjunctival windows were performed (nasal and temporal). Main outcome included symptomatic relief, restoration of bleb architecture, and preservation of filtration.

Six eyes from 6 patients underwent BWP. The mean follow-up period was 6.6+/-1.7 months (3.5 to 8.3 mo). All patients documented a rapid symptomatic relief within the first postoperative day. All had successful reduction in bleb size and adequate filtration without further antiglaucoma medications or surgery. Best corrected visual acuity improved 2 Snellen lines in 1 eye. Lens status remained unchanged in all cases. No complications or recurrences were noted.

Early results showed that BWP is safe, easy, and minimally invasive technique for the rapid relief of dysesthesia symptoms from dysmorphic filtering blebs. A larger sample size with longer follow-up is necessary to confirm the clinical utility.