Fungal corneal ulcer after repair of an overhanging filtering bleb:A case report

BACKGROUND Overhanging filtering bleb is a common complication after trabeculectomy and surgical repair is an effective treatment when the patient presents with apparent symptoms.Filtering bleb relevant infection including in the filtering bleb itself and even endophthalmitis in some severe cases has been reported.However,corneal fungal infection after filtering bleb repair is rarely reported.CASE SUMMARY A 57-year-old Chinese man who had sensations of redness and foreign body sensations in the left eye 3 wk after repair of overhanging filtering bleb.3 wk ago,due to sensations of a foreign body in the left eye for 3 years with worsening for 3 mo.The patient was diagnosed as overhanging filtering bleb and underwent a repair of overhanging filtering bleb.Postoperative,the filtering bleb formed well and the intraocular pressure is normal.But the patient gradually develop redness,pain and a grey infiltrate of the cornea in the eye.Finally it developed into fungal corneal ulcer.Through asking the medical history,we found the patient had irregularly self-medicated for years with glucocorticoid eye drops for years to relieve the foreign body sensation in the eye caused by filtering bleb overhanging.Because the glucocorticoid eye drops he used years ago had provide normal sensation to the eye.After 3 mo of anti-fungal treatment,the inflammation was controlled.CONCLUSION In addition to avoiding the development of overhanging filtering bleb after trabeculectomy,the present case report also suggests that clinicians should pay more attention to the patient’s ocular self-medication history.Particularly in patients with a history of glaucoma or eye surgery.Because these patients may be exposed to more types of eye drops than other individuals,they may select the wrong medi-cations for long-term use,based on their previous experience.

Functional evaluation of the filtering bleb by ultrasound biomicroscopy after trabeculectomy with mitomycin C

AIM： To study the role of ultrasound biomicroscopy（UBM） in the assessment of the bleb function after trabeculectomy with mitomycin C（MMC）. METHODS： This was a cross-sectional study including all cases had undergone trabeculectomy with MMC 0.2 mg/mL for 3 min. Participants were recruited from the follow-up cases at Department of Ophthalmology, Tanta University in the period from August 2015 to August 2016. Full history taking and ophthalmological examination were performed. Intraocular pressure（IOP） was measured using Goldmann applanation tonometry and the history of prescribed postoperative antiglaucoma medications was recorded. Accordingly, the trabeculectomy blebs were divided clinically into successful blebs when the IOP post-operative was ≤18 mmHg without medications. Scanning examination of the filtering bleb using UBM examination was performed at the period from 2 to 36 mo after trabeculectomy（13.6±9.7 m o）. RESULTS： This study included 33 trabeculectomy filtering blebs of 25 patients（9 males and 16 females）. The mean age of patients was 53.2±14.2 y（range 25-71y）. We had 20 eyes with complete success, 9 eyes with qualified success, and 4 eyes with failure after trabeculectomy with MMC. The blebs were classified into successful blebs（IOP ≤18 mmHg without antiglaucoma medications）, others were classified into qualified successful and failed blebs. There was a significant correlation between certain UBM findings（intra-bleb reflectivity, draining sub-scleral tract, bleb height, and intrableb fluid cysts） and cases with different grades of clinical functional success（P〈0.01）.CONCLUSION： UBM is an objective tool in the functional assessment of the post-trabeculectomy filtering bleb through a significant correlation between certain UBM parameters and the different grades of clinical functional success.

Efficacy of autologous conjunctival flap on repairing the late-onset filtering bleb leakage

AIM： To evaluate the effectiveness of autologous conjunctival flap surgery for repairing the late-onset filtering bleb leakage after trabeculectomy.METHODS： This study retrospectively reviewed 106 eyes from 106 patients with late-onset filtering bleb leakage after trabeculectomy who received autologous conjunctival flap surgery at the Zhongshan Ophthalmic Centre from 2005 to 2015. The basic information was recorded, and the interval time between trabeculectomy and autologous conjunctival flap surgery as well as related risk factors, intraocular pressure（IOP）, anterior chamber depth（ACD） and best corrected visual acuity（BCVA） were analysed. Moreover, 41 patients who completed the 1-year follow up were analysed to determine the IOP and BCVA changes and long-term success rates.RESULTS： The 50 male and 56 female subjects（average age 39.13±17.96 y） included 47（44.34%） and 33（31.13%） cases of primary open angle and primary angle-closure glaucoma. The mean interval between trabeculectomy and repair surgery was 60.60±56.92（3-264）mo. The mean mitomycin（MMC） concentration during trabeculectomy was 0.27±0.04（0.12-0.4） mg/m L in the fornix-based conjunctival flap group（68 patients） and 0.28±0.04（0.20-0.33） mg/m L in the limbal-based conjunctival flap group（11 patients）. After bleb leakage, the patients＇ vision remained stable while the IOP decreased from 10.25±4.76（3-20.86） to 9.44±4.33（2-21） mm Hg（P〈0.01）. In the 41 analysed patients, the IOP was controlled at 15.68±5.11（7-40） mm Hg in the 1^（st） year after autologous conjunctival flap surgery and recurrence was not observed, for a long-term success rate of 100%. CONCLUSION： Autologous conjunctival flap repairing surgery is an effective technique for sealing filtering bleb leakages and controlling IOP postoperatively.