Intra-Bleb Pigmentation after Trabeculectomyt
BOONSONG WANICHWECHARUNGRUANG, MD*, WORA WAN NARUMITCHAI, MD*
Affiliation : *Glaucoma Service, Department of Ophthalmology, Rajavithi Hospital, Bangkok 10400, Thailand. t Presented in part at the 6'h Congress of the European Glaucoma Society, London, June 2000.
Purpose : To report the presence of intra-bleb pigmentation (IBP), appearing after trabecu lectomy and combined clear cornea phacoemulsification, intraocular lens (IOL) implantation and trabeculectomy (combined surgery).
Method : Ten eyes of 8 Asian patients with IBP were studied. Four eyes underwent trabecu lectomy for uncontrolled glaucoma, and 6 eyes underwent combined surgery for cataract coexisting with glaucoma. Seven of the 10 eyes had adjunctive mitomycin C for the procedures.
Results : Mean follow-up time was 11.6 months (range 3-15 months). Five of the 10 eyes had intra-operative and post-operative complications requiring intraocular manipulation (ruptured posterior capsule and in-the-sulcus IOL, flat anterior chamber, malignant glaucoma, iris prolapse). Blebs were thin (8 eyes), or with moderate thickening of conjunctiva (2 eyes) with IBP either overlying the scleral flap or spread beneath the conjunctiva. IBP initially appeared at 2 to 44 weeks after the procedures. Nine of the 10 eyes (90%) had lOPs~ 22 mmHg without medication.
Conclusion : IBP is associated with iris trauma at surgery and dispersal of pigment into the bleb, where it spreads or proliferates. A thin bleb provides a clear view of IBP as well as functional filtration. IBP appears to be a favorable sign of the filtration.
Keywords : Trabeculectomy, Combined Surgery, Complications, Filtering Bleb, Pigmentation
