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Photo Essay
November 1999

Surgical Repair and Histopathologic Features of a Dissecting Glaucoma Filtration Bleb

Arch Ophthalmol. 1999;117(11):1566. doi:10.1001/archopht.117.11.1566

A 75-YEAR-OLD woman with a history of a branch retinal vein occlusion and a visual acuity of 20/200 OS underwent trabeculectomy in the left eye for open-angle glaucoma not controlled by maximally tolerated medical therapy in August 1994. An internal revision of the filtering bleb was carried out for early bleb failure in March 1995. Five injections of subconjunctival fluorouracil were subsequently given in the immediate 2-week postoperative period.

By November 1996 the left filtration bleb was noted to be high-domed and thin-walled. A year later, the bleb exhibited corneal extension with progression during the ensuing months. In May 1998, the patient noted a "foreign object" on the left cornea accompanied by decreased vision and increasing foreign-body sensation. The foreign object was in fact the dissecting filtration bleb, which had continued to advance over the cornea. Topical lubricants were used to temporize. By December 1998 the appearance of the bleb was as in Figure 1. At this time the patient's visual acuity had been reduced to 20/400 OS and the patient complained of a constant foreign body sensation.