Background
The consequences of bleb-associated complications include the following, listed in order of potential morbidity:
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Predisposition to or cause of infection
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Unsatisfactory bleb function (ie, intraocular pressure [IOP] too low, IOP too high)
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Dysesthesia
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Decreased visual acuity
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Loss of the globe, which can be the final outcome
Pathophysiology
The goal of glaucoma filtering surgery is to reduce IOP with surgery. The pressure can be too high or too low following the surgery.
Epidemiology
Frequency
United States
This condition is uncommon.
Mortality/Morbidity
Bleb complications can be classified according to their vision-threatening potential and impact on quality of life.
All bleb-related complications have infection/endophthalmitis as a possible consequence, with high morbidity. [1] Also, bleb failure with consequent rise in IOP or excessively low IOP are possible consequences.
The cost for the individual and the community in terms of discomfort, unplanned care, loss of work time, direct medical expenses, and decrease in visual function cannot be estimated and may be high.
Race
No racial predisposition exists.
Sex
No sexual influence exists.
Age
No influence of age exists.
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Retraction of a fornix-based conjunctival flap. It can progress to uncover the scleral flap.
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Suboptimal suturing techniques can cause gaping of the conjunctival incision.
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Fluorescein staining of the conjunctiva shows an obvious leakage of aqueous.
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After fluorescein staining, aqueous is percolating slowly, forming tiny droplets on the surface that mimic a sweating bleb.
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Cystic, thick-walled bleb, defined most commonly as a Tenon cyst.
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Large, extended, overfiltering bleb causes symptoms because of tear flow disturbances and ocular surface wetting.
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Corneal dissecting bleb, extending forward within the corneal epithelium.
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Seidel test. While holding the upper lid to avoid blinking during this evaluation, a dry fluorescein strip is moved over the conjunctival bleb, so as to smear it with dry fluorescein, which will appear very dark under blue light. As soon as the aqueous leaks, the color will turn to very bright yellow.
