Question
An elderly patient underwent an uncomplicated trabeculectomy of the right eye. The next day, the IOP was 1 mm Hg and the patient had the slit-lamp appearance shown in Figure. The bleb is flat. The retina and choroid appear normal. What is the most likely cause of these findings?
| A. |
Malignant glaucoma
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| B. |
Choroidal detachments
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| C. |
Bleb leak
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| D. |
Excessive filtration
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Show Answer
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Correct Answer � C
Explanation
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Answer: C) Bleb leak
Explanation: A low, often unrecordable IOP is common during the early postoperative period and is typically associated with a shallow anterior chamber. If there is an obvious hole in the conjunctiva, one would see brisk Seidel positivity and a flat bleb. Spontaneous closure of the defect often is possible with a pressure patch; however, if this technique is not effective, a Simmons scleral compression shell may help close the leak. Other treatment options for bleb leak include defect suturing, trichloroacetic acid, soft contact lens, and autologous blood injection. Fluid commonly collects in the suprachoroidal space in hypotonous eyes, leading to serous choroidal detachments. The fluid in the detachments is high in protein (67% of plasma concentration). Most serous choroidal detachments resolve spontaneously along with the normal rise in IOP during the first few postoperative days or weeks. In other cases, there may be no apparent conjunctival defect, but filtration may simply be excessive as a result of a large fistula or filtering bleb. Malignant glaucoma is associated with an elevated IOP and a flat anterior chamber.
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