| Blebs |
Question: What effect could a vitrectomy have on a working bleb?
Answer:
Any intraocular surgery could affect the functioning of the glaucoma surgery, usually because post-op inflammation may lead to scarring of the glaucoma drain.
Dr. Michael James Pro
May 2, 2007
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Question: I had a conjunctival advancement to repair a leaking bleb. Despite it being a simpler procedure than a trab, I experienced a lot more discomfort, swelling, and pain. Are subsequent procedures often harder on the eye?
Answer:
Yes. Your conjunctiva was stretched further than it wanted to go and then held in place by sutures; this can be uncomfortable.
Dr. Rick Wilson
April 7, 2007
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Question: I had a subconjunctival hemorrhage (blood vessel breakage) a couple of months after a trab. Can the trab, and the steroids used for it, be contributing factors?
Answer:
Usually after a trab, the conjunctiva is lifted off the globe by the intraocular fluid coming out of the eye through the trabeculectomy. This puts it in harm's way as the lids bat together frequently. If the conjunctiva is caught between the lids, a vessel can break, causing the subconjunctival hemorrhage. Steroids possibly make vessels weaker.
Dr. Rick Wilson
April 7, 2007
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Question: My bleb-revision surgery involved dealing with "ring of steel" scar tissue, which prevented the bleb from being diffuse. Is it likely that this ring will reform?
Answer:
This tissue forms as a response to mitomycin C, which was probably used during the original surgery. If no mitomycin was used on the second surgery, than the "ring of steel" is unlikely to re-form.
Dr. Michael James Pro
March 21, 2007
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Question: My leaking bleb isn't healing on its own. My glaucoma specialist says he will do a "window shade" procedure, where he will excise old tissue and pull more conjunctiva over the failing bleb. What is the proper medical term? Is it likely that this newly revised bleb will last as long as the original bleb (five years)?
Answer:
The term is a conjunctival advancement, and it is a good procedure to repair a leaking bleb. You describe it accurately. There is no long-term data on bleb survival after a conjunctival advancement. A good prognostic indicator for general bleb survival is how the bleb is working at one year. If the bleb is working well, then the long-term outlook is good.
Dr. Michael James Pro
February 21, 2007
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Question: Is a conjunctival advancement the same as a revison of a trabeculectomy?
Answer:
Revision of a trab can mean many things; it is a blanket term for a surgical repair or revision. Conjunctival advancement is more descriptive of one type of revision.
Dr. Michael James Pro
February 21, 2007
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Question: What questions should I ask my doctor about my year-old bleb to help me assess its condition?
Answer:
You could ask if the bleb looks vascularized or thickened. That could be a sign that the bleb has changed. If the pressure has been stable, but now starts to rise significantly, that could be a sign that the bleb is not functioning as well.
Dr. Michael James Pro
February 21, 2007
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Question: I had a trabeculectomy eight years ago. The bleb tissue is now thinning, and the bleb is leaking on occasion. Do you use drops in such cases to help take the pressure off the bleb? Is this a good alternative to revision of the bleb?
Answer:
I routinely use drops to lower the aqueous pressure on a leaking bleb. This may not be adequate to prevent further leaks and the danger of infection that leaks represent. While a revision is safest, a trial of such medication to see if the leak can be stopped would certainly be a reasonable risk if you were watched carefully.
Dr. Rick Wilson
February 7, 2007
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Question: I had a leaking bleb and a drop was used to relieve the aqueous pressure. At my next exam, there was no leak. Should I be checked regularly for leaks?
Answer:
Yes, that would be wise. I would also continue the drop to keep the aqueous pressure down.
Dr. Rick Wilson
February 7, 2007
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Question: What causes a cyst to form in a bleb?
Answer:
A trabeculectomy ends up leaving a small hole in the wall of the eye, through which the aqueous exits the inner part of the eye. The outer layer of the eye may react to this fluid, which is not normally there, and build a wall of scar tissue around the hole in the eye wall. This results in a "cyst". High cysts that look like igloos usually eventually lessen in height and in resistance to fluid passing through the wall of the cyst.
Dr. Rick Wilson
January 3, 2007
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Question: If you have a bleb, does blepharitis [infection of the eyelid] increase the risk of infection in that eye?
Answer:
Yes. Patients with chronic blepharitis are at risk for bleb infections, so the blepharitis should be treated vigorously.
Dr. Elliot Werner
June 7, 2006
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Question: What is a bleb?
Answer:
When the fluid seeps its way out through the sclera flap formed by the trabeculectomy, it is trapped under the conjunctiva which is the clear, most superficial layer of the eye overlying the sclera. This forms a bulge called a bleb.
Dr. Rick Wilson
September 14, 2005
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Question: Will needling affect the longevity of a bleb?
Answer:
In most cases, it will lengthen the functional time for the bleb, often for several years.
Dr. Rick Wilson
April 26, 2006
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Question: How important is it to keep water out of an eye with a bleb?
Answer:
If the bleb is not thin, with aqueous "sweating" through the bleb, then getting water in your eye should not be a problem.
Dr. Rick Wilson
August 2005
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Question: Can the straining during the birth process do any damage to a bleb?
Answer:
Usually not. If the bleb is very thin, then it could be hurt by an extreme contraction of the eyelids onto the eye.
Dr. Rick Wilson
February 8, 2006
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Question: What are the warning signals of a bleb infection?
Answer:
'RSVP' is a good way to remember them: Redness; increased Sensitivity, especially to light; change in Vision; and Pain.
Dr. Rick Wilson
February 1, 2006
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Question: Is cryosurgery effective for reducing a large bleb? How long would it take to heal?
Answer:
Cryotherapy as well as laser and cautery have been effective in reducing large blebs. It takes about three weeks after cryosurgery for the eye to start looking normal again.
Dr. Rick Wilson
December 21, 2005
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Question: Is it common for a bleb, four months after having a trabeculectomy, to start burning and drying out the eye? Why would a bleb be so big that it covers half the eye?
Answer:
No, but perhaps the burning and drying coincided with the start of seriously cold weather and the dry heat used to combat it. Because the bleb sticks up, it is more sensitive if the conjunctiva is not moist enough for the lid to slide easily over it. A good bleb covers half the eye (the top half). A superb bleb goes 360 degrees around the eye.
Dr. Rick Wilson
December 21, 2005
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Question: Can lifting weights of more than 10 lbs hurt blebs?
Answer:
Usually not, but straining does raise the eye pressure, so I would not hold the strain a long time if there is bad glaucoma present.
Dr. Rick Wilson
October 5, 2005 |
Question: My recent trabeculectomy has a very large bleb. Should my surgeon make it smaller, or will it get smaller in time on its own?
Answer:
Usually aqueous fluid filtering through the hole in the sclera created by a recent trabeculectomy spreads out over a large area under the conjunctiva. This creates the bleb. Over time, the body constricts the bleb with scar tissue so that it becomes more localized to the area right over the original surgery. The pressure of the aqueous coming out of the eye is concentrated on a smaller area of conjunctiva, often thinning it, occasionally to the point that holes form in the conjunctiva and aqueous leaks out into the tears. Large blebs are preferable to small blebs because the fluid pressure is spread out over a larger area and there is less thinning of the conjunctiva. Therefore, unless a bleb is unsightly or uncomfortable, we usually leave it alone. Trying to reduce its size may reduce its effectiveness at lowering IOP.
Dr. Rick Wilson
October 5, 2005 |
