Inadvertent Filtering Bleb

• Wound leak under sealed overlying conjunctiva.
• May occur, particularly following cataract surgery using limbal or scleral incision techniques complicated with wound dehiscence.

Clinical Features

• Symptoms:
  • May be asymptomatic
  • Tearing due to wound leaking
  • Decreased vision
• Signs:
  • Subconjunctival microcysts or bleb
  • Wound gape
  • Seidel test (+)
  • Hypotony
  • Corneal folds
  • Shallow anterior chamber
• May be complicated by hyphema, endophthalmitis, choroidal effusion, choroidal folds or papilledema.

Management

• No treatment necessary if asymptomatic and no further risks or complications observed.
• Surgical repair by wound resuturing or bleb excision may be considered in cases with:
  • Large, cystic thin-walled bleb
  • Persistent hypotony
  • Poor tissue apposition
  • Iris prolapse
  • Astigmatism