A giant bleb over a non-valved tube successfully treated with compression sutures

To report a rare case of an anteriorly enlarged giant bleb following Ahmed ClearPath 350 glaucoma drainage device implantation, successfully treated with compression sutures.

A 50-year-old man with a history of primary open angle glaucoma and multiple prior glaucoma procedures presented with a progressively enlarging inferonasal conjunctival bleb in the right eye, six months after Ahmed ClearPath 350 implantation. Examination revealed visual acuity (VA) of 20/40, intraocular pressure (IOP) of 6 mmHg, and a large, elevated, fluid-filled conjunctival bleb. While bleb formation is a desired outcome following glaucoma drainage device (GDD) implantation and trabeculectomy, the increasingly large size of this bleb caused discomfort, worsening vision, and difficulty closing the eye. Due to its rare nature, there was little consensus available regarding treatment. Compression sutures were placed in attempt to flatten the bleb. At one-week follow-up, vision and discomfort improved and slit-lamp examination revealed a markedly flatter bleb. Sutures were sequentially removed via slit-lamp during the one-month and two-month postoperative visits. At one-year follow-up, VA was 20/25, IOP was 6 mmHg, and slit lamp examination revealed a completely flattened inferonasal bleb.

This case highlights a rare presentation of a giant inferonasal conjunctival bleb developing several months after Ahmed ClearPath 350 implantation. The successful use of compression sutures suggests they may be a viable treatment option for similar post-GDD implantation bleb complications.