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S. Cronemberger, H.A. Maestrini, J.M. Reimann, N. Calixto; Diagnosis and Treatment of Hyperfiltering Blebs . Invest. Ophthalmol. Vis. Sci. 2006;47(13):12.
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to report the criteria that the authors have established to diagnosis a hyperfiltering bleb and the results of bleb resection for the treatment of this kind of complication following trabeculectomy with mitomycin C.
thirteen eyes from 13 patients with ocular hypotony caused by hyperfiltering bleb underwent bleb resection. The diagnosis of hyperfiltering bleb was made according to the following criteria: IOP below 6 mmHg measured by Goldmann applanation tonometer; absence of signs of inflammation in the anterior segment at biomicroscopy; elevated and/or diffuse and avascular bleb with or without microcysts inside it; negative Seidel test, even after a slight compression of the ocular globe; absence of ciliochoroidal detachment carried out by ultrasound biomicroscopy in the superior, inferior, nasal and temporal quadrants. The minimum follow–up was of six months.
the ocular hypotony was reversed in all eyes (eight without medication and five with topical antiglaucomatous medication). Five eyes had the hypotonic maculopathy reversed. The best corrected visual acuity improved in 11 eyes (84.6%) and did not change in two eyes (15.4%). The mean follow–up was of 23.0 ± 15.2 months (range from six to 50 months).
rigorous criteria should be established to diagnosis correctly a hyperfiltering bleb. Bleb resection is a good approach for the treatment of ocular hypotony secondary to hyperfiltering bleb, restoring the vision of most patients.
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