Leaking Bleb After 50 Years of Historical Iridencleisis Surgery: A Case Report

We describe a case of historical iridencleisis surgery in a patient who initially presented to our hospital with leaking blebs, presumed to be secondary to trabeculectomy. The patient was a 70-year-old male with a history of an uncertain glaucoma surgery performed on his left eye at 18 years of age (1973). At presentation, his intraocular pressure (IOP) was 3 mmHg and visual acuity was hand motion. Examination revealed a positive Seidel test from a diffuse, large ischemic bleb with a large iridectomy. Given a history of two prior episodes of blebitis, we planned bleb reconstruction surgery. Intraoperatively, we discovered invaginated iris tissue without a scleral flap, a finding distinct from conventional trabeculectomy. We created a rectangular, half-thickness autograft scleral flap from an adjacent site and used it to cover the invaginated iris, thereby stopping the aqueous humor leakage. These intraoperative features confirmed that the original procedure was iridencleisis, a historical surgical technique developed by Søren Holth in 1907. This procedure was widely used until the 1950s but subsequently declined due to the risk of sympathetic ophthalmia and insufficient safety and predictability. Postoperatively, aqueous humor leakage ceased and IOP increased. Although severe visual field defects persisted, the patient's visual acuity improved to 0.7 (logMAR) following cataract surgery, and IOP remained stable at approximately 14 mmHg. We report a rare case of historical iridencleisis surgery, noting that its blebs resembled those of trabeculectomy despite the absence of antimetabolite use.