Surgical Management for Refractory Bleb Dysesthesia

Table 1

Demographic characteristics, dysesthetic bleb characteristics, and surgical outcomes of series of consecutive cases.

	Case 1	Case 2	Case 3	Case 4
Demographic characteristics
Sex/age	M/69	M/69	F/72	F/81
Type of glaucoma	POAG	POAG	POAG	POAG
IOP (mmHg)	21	17	18	16
Topical treatment	PG + β + α	PG + β + α	PG + CAI + α	PG + β + CAI
BCVA	20/50	20/32	20/40	20/40
Primary procedure	PT + MMC	PT + MMC	PT + MMC	PT + MMC
Additional treatment	LSL#3 + 5FU#7	LSL#1 + 5FU#2	LSL#1 + 5FU#1	No
BCVA	20/25	20/25	20/40	20/40
IOP (mmHg)	9	10	6	12
VCDR	0.85	0.95	0.9	0.8
OCT	50	47	52	54
VF-MD (dB)	−16.75	−23.3	−30.44	−28.10
Dysesthetic bleb characteristics
Elapsed time (mo) from primary surgery	13	11	4	9
IBAGS	2(H) × 3(E)	2(H) × 3(E)	3(H) × 3(E)	3(H) × 3(E)
Extension	110°	180°	200°	180°
Signs	Red eye	Red eye	Red eye Dellen	Red eye Dellen
Symptoms	FBS	FBS	FBS	FBS
Lubrication topical treatment	SH 1gtt/h + C 1app/n	SH 1gtt/h + C 1app/n	SH 1gtt/h + C 1app/n	SH 1gtt/h + C 1app/n
Elapsed time (mo) to bleb reduction	2	1	1.5	3
Surgical outcomes
Type of surgery	CP + E	CP	CP	CP + E
Signs/symptoms	—/—	—/—	—/—	—/—
IOP 24 hrs (mmHg)	12	10	17	26
IOP 1 mo (mmHg)	10	8	10	14
IOP 6 mos (mmHg)	12	10	10	14
IOP 12 mos (mmHg)	12	10	10	14
VCDR	0.85	0.95	0.9	0.8
OCT	50	52	54	56
VF-MD (dB)	−13.25	−23.85	−30.51	−28.97
BCVA	20/25	20/25	20/40	20/40

M: masculine, F: feminine, POAG: primary open-angle glaucoma, IOP (mmHg): intraocular pressure (millimeters of mercury), PG: prostaglandin analogues, β: beta blocker, α: alpha adrenergic agonist, CAI: carbonic anhydrase inhibitor, BCVA: best-corrected visual acuity, PT: phaco + trabeculectomy, MMC: mitomycin C, LSL: laser suturolysis, 5FU: 5 fluorouracil, VCDR: vertical cup to disc ratio, OCT: optical coherence tomography, VF-MD(dB): visual field mean deviation (decibels), mos: months, IBAGS: Indiana Bleb Appearance Grading Scale [6], H: height, E: horizontal extent, FBS: foreign body sensation, SH 1gtt/h: sodium hyaluronate 1drop every hour, C 1app/n: carbomer 1 application every night, CP + E: conjunctivoplasty + excision of subconjunctival connective tissue, and CP: conjunctivoplasty.