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Thin-walled Cystic Bleb
- More frequently developed following full-thickness filtration surgery or an antiproliferative-enhanced trabeculectomy.
- Complications commonly associated with full thickness filtration procedures are formation of an exuberant bleb due to a lack of aqueous flow resistance, over-filtration with resultant early hypotony, shallow anterior chamber, cataract, corneal decompensation and choroidal detachment.
- Complications associated with antiproliferative application include corneoscleral, ciliary body and vitreoretinal toxicity, conjunctival wound leak, bleb rupture, and progression of cataract.
- Vision loss due to hypotony or hypotonic maculopathy, although rare, is more likely associated with the use of mitomycin-C.
- Thorough evaluation of the bleb post-operatively to assess potential filter failure, conjunctival leak, infection and other complications.
- Large soft contact lenses (18 - 22 mm) have been reported to be helpful in the management of leaking blebs.
- Rigid glaucoma shell is also useful in managing friable conjunctival tissues with multiple holes.
- Excision of the conjunctival tissue or subconjunctival fibrosis, cryotherapy, argon laser, or revision surgery may be needed to improve the filtration bleb.