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Antimetabolites may increase likelihood of leaking blebs
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 Eydie Miller-Ellis |
ROME — In the quest for successful glaucoma surgery, antimetabolites are more commonly being used, but they are a mixed blessing, according to a speaker here.
"We have lower pressure, but we end up with blebs that tend to be avascular and thin, much more prone to leak, and more at risk for blebitis and bleb-related endophthalmitis," Eydie Miller-Ellis, MD, said at the annual joint meeting of Ocular Surgery News and the Italian Society of Ophthalmology.
"Whenever I have a patient that has a thin bleb, I stain it with fluorescein and check it for leakage. Some leaking blebs are asymptomatic, and you can catch them and treat them before they become a problem for the patient," she said.
Her approach to leaking blebs is to use a nonsurgical therapy as initial intervention with a large, 24-mm-diameter contact lens to cover the entire bleb.
"I leave the lens on for 5 to 7 days and then re-evaluate. If the leak is still as brisk as it was before, I consider a surgical intervention," Dr. Miller-Ellis said.
"I dissect away the conjunctiva, denude the bleb and then reinforce the bleb with a tissue graft, from donor scleral or pericardial tissue. Then I cover the area with conjunctiva, either the adjacent conjunctiva or a free conjunctival graft from the same or the fellow eye," she said.
Surgeons should consider that repaired blebs may result in elevated IOP and require restart or addition of medications, Dr. Miller-Ellis said.
- Disclosures: Dr. Miller-Ellis has no relevant financial disclosures.