EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/1422338
86 | EYEWORLD | DECEMBER 2021 by Ellen Stodola Editorial Co-Director About the physician Meenakshi Chaku, MD Associate Professor of Ophthalmology Loyola University Medical Center Maywood, Illinois A patient may be at risk for a bleb leak after trabeculectomy, either in the early postop period or years after surgery. Meenakshi Chaku, MD, shared considerations for this poten- tial complication, how she monitors patients, and what to do if a bleb leak does occur. Dr. Chaku noted that the likelihood of a bleb leak occurring varies. Management of this issue would depend on when it occurs and if an infection is present at the time of occurrence. One of the most important things to do, she said, is to watch the patient for infection. Occasionally, bleb leaks can occur early in the postoperative period, especially if the pa- tient has poor tissue healing. However, she noted that any glaucoma specialist could encounter a late onset bleb leak. It can happen for any patient with prior tra- beculectomy, especially if the tissue is more isch- emic and thinner over the surgery site. Thus, it's important to check for evidence of a bleb leak each time patients with a previous trabeculecto- my come into the clinic. Comorbidities and considerations In terms of specific comorbidities to be aware of that could increase the instance of a bleb leak after surgery, Dr. Chaku said to be cautious of patients with a thinner conjunctiva. Other risk factors include older age, previous history of inflammation, or long-term use of topical hypo- tensive medications, which can decrease tissue quality over time. When performing the trabe- culectomy, Dr. Chaku said the way you open the conjunctiva also plays a role. A limbus-based approach tends to have less chance of a bleb leak than a fornix-based approach because it's more posterior. Additionally, she mentioned that the use of an antimetabolite, like mitomycin-C, could increase the risk of poor healing and bleb leak, but it is necessary to help in the success of the surgery. The problem, she said, is "we want pa- tients to heal at their surgery site, but we don't G UCOMA Handling bleb leaks COMPLICATED CASES continued on page 88 Late-onset bleb leak Source: New York Eye and Ear Infirmary of Mount Sinai