Functioning Filtering Bleb

Normal glaucoma filtration bleb after uncomplicated trabeculectomy with antiproliferative therapy
  • Glaucoma filtration surgery is indicated when other available treatment modalities such as medications and laser therapies have failed to control the intraocular pressure level or to prevent against progression of the disease (e.g. visual field loss or optic disc cupping).
  • The use of adjunctive antiproliferatives (5-fluorouracil and mitomycin-C) to prevent subconjunctival tissue scarring after glaucoma filtration surgery has increased the successful control of intraocular pressure in eyes at a high risk of surgical failure (e.g. neovascular glaucoma, uveitic glaucoma, previous failed bleb, younger age patient).
  • Characteristics of antiproliferative-associated filtering blebs:
    • Pale
    • Avascular (ischemic),
    • Localized cystic bleb with surrounding zone of increased vascularity
  • Post-operative assessments to ascertain filtration bleb functionality and to detect potential complications include vision and intraocular pressure, wound leak (Seidel test), anterior chamber depth, corneal clarity and epithelium integrity, and presence of suprachoroidal hemorrhage or choroidal effusion detachment.