Application of handheld cautery for reduction of symptomatic circumferential trabeculectomy blebs
Arthur L Schwartz1, Marissa Albano
1Georgetown University/Washington Hospital Center, USA.
Purpose:
To describe a new, in-office procedure for limiting symptomatic, circumferential conjunctival blebs occurring after trabeculectomy.
Patients:
Two eyes of 2 patients status postfornix-based trabeculectomy with mitomycin C were found to have symptomatic circumferential blebs.
Methods:
Risks and benefits of cautery were discussed, along with alternatives including continued conservative treatment or surgical revision. The patients opted for in-office cautery. Two eyes of 2 patients underwent cauterization of their blebs with a Bovie high temperature handheld cautery in the office after topical pretreatment with 2.5% neosynephrine and 4% xylocaine. Excess fluid was drained from the bleb by expression through the puncture wounds. The wounds were Seidel negative immediately after the treatment.
Results:
Flattening of the bleb occurred instantly, patients did not experience pain and their symptoms related to the extensive bleb resolved. The functioning of the bleb was not altered in these 2 cases by this procedure.
Conclusions:
Early results show that handheld cautery may be a useful means of treating symptomatic circumferential blebs.