Surgical management and histopathological features of symptomatic overhanging filtering blebs

Objective To described methods and outcomes of a sutureless technique for partial excision of symptomatic overhanging bleb and reported the histopathological findings.Methods A retrospective case series of 10 eyes of 9 patients who underwent trabeculectomy.A sutureless partial excision procedure was offered to 10 eyes with overhanging blebs.Data on age,sex,presenting symptoms,glaucoma types,type of prior filtration surgery,pre-and post-best corrected visual acuity,pre-and post-excision intraocular pressure (IOP),bleb morphology,corneal surface,complications of excision,ultrasonic biomicroscopy images and histopathotogical imaging were collected.The length of follow up ranged from 4 months to 5 years.Data were analyzed using paired t test.Results The length of follow up was (28.8±19.8) months.Before the surgical excision,Ultrasonic biomicroscopy imagings showed that the bleb tissues were tightly attached to the cornea and some parts of the blebs were fluid-filled.Successful excision of the overhanging bleb was achieved for all the cases.There was satisfactory control of IOP and the cornea remained clear.No case of recurrent overhanging bleb was found in the period of follow-up.This surgical technique did not lead to leakage,hypotony,and endophthalmitis during the period of follow up.Histopathological examination showed that the excised tissues mainly consisted of fibrous connective tissue and corneal epithelial tissue embedded with cyst-like structures.Conclusion Sutureless partial excision of the overhanging blebs seems to be a simple and safe means that helps in revising the blebs,relieving discomfort,and ensuing IOP control. Key words: Glaucoma;  Overhanging filtering blebs;  Complications;  Ophthalmologic surgical procedures