Blebophthalmos: proptosis due to a massive bleb following implant surgery in refractory paediatric glaucoma. Issue 5 (13th May 2020)

• Record Type: Journal Article
• Authors: Gollakota, Sriramani; Balijepalli, Pasyanthi; Richhariya, Ashutosh; Senthil, Sirisha
• Is Part Of: BMJ case reports. Volume 13:Issue 5(2020)
• Publication Date: 2020-05-13
• Subjects: glaucoma -- anterior chamber -- paediatrics; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2020-234454
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : A 5-year-old boy with failed combined trabeculotomy and trabeculectomy underwent Ahmed glaucoma valve (AGV) implantation and presented 5 weeks postoperatively, with sudden onset proptosis downward displacement of the globe, limited extraocular movements and displacement of tube from anterior chamber. CT scan of the orbits showed a large cystic bleb with posterior dislocation of the implant and was explanted. In vitro testing of implant for fluid flow characteristics revealed a dysfunctional valve with anterior leak, which could have possibly lead to anterior and inferior fluid accumulation resulting in displacement of implant, a probable cause for this rare complication. The case was successfully managed later with the Aurolab aqueous drainage device implantation. This case report cautions the surgeon for the possibility of a large cystic bleb following abnormal leak in AGV resulting in orbital complications like proptosis, motility limitation and impending optic nerve compression.