Isopropyl Alcohol in Bleb Revision: A Novel Approach for Aesthetic and Functional Success

BACKGROUND Overhanging filtering blebs (OFB) are a known complication of trabeculectomy, leading to visual disturbances, discomfort, and cosmetic concerns. Their management remains challenging, with high recurrence rates despite surgical interventions. This case report presents the clinical course, management, and outcome of an 18-year-old woman with an OFB who underwent bleb revision incorporating isopropyl alcohol as an adjunctive measure. CASE REPORT An 18-year-old woman with a history of trabeculectomy and prior bleb revision presented with a large, cystic, overhanging filtering bleb that extended toward the cornea, causing cosmetic concerns and discomfort. Her best-corrected visual acuity (BCVA) was 20/100 in the affected eye, and an intraocular pressure (IOP) was 8 mmHg. She underwent surgical revision involving bleb excision, conjunctival reapproximation, and application of 70% isopropyl alcohol to de-epithelialized corneal tissue to reduce the risk of recurrence. Postoperatively, the bleb was well formed, IOP remained stable at 10 mmHg without any IOP-lowering medications, and the patient reported significant cosmetic improvement. No complications or recurrences were observed at the 1-year follow-up. CONCLUSIONS This case highlights a potential role for isopropyl alcohol in the surgical revision of OFB. The technique was associated with a favorable functional and cosmetic outcome. Further studies are warranted to assess its long-term efficacy and broader applicability in glaucoma surgery.