Titel | Patient creates filtering bleb: hypotony following traumatic rupture of an old scleral tunnel for cataract surgery |
Doel | To describe a case where a patient involuntarily creates a filtering bleb, many years after cataract surgery. |
Methodes | An 86-year old woman was referred because of symptomatic hypotony on the left eye since a few weeks, with blurry vision and a very sensitive eye. She had a history of bilateral intracapsular cataract extraction (ICCE) in 1980 and secondary intraocular lens (IOL) implantation in 1982. The patient mentioned a fall on the head with concussion six months earlier. At presentation, best corrected visual acuity (BCVA) was 20/40 OS. Intraocular pressure was 4 mmHg. Anterior segment exam showed a superonasal filtering bleb and the fundus exhibited macular folds. The diagnosis of a superior scleral fistula was made, and confirmed by gonioscopy. A causal relationship between the head injury and the presence of a scleral fistula seemed very likely, with the location of the fistula probably corresponding to a previously made surgical incision created while performing ICCE. It was decided to opt for surgical repair of the fistula. |
Resultaten | Two months after presentation, closure of the scleral fistula in the left eye was performed. Two weeks postoperatively, the patient achieved 20/33 BCVA and a 14 mmHg IOP with resolution of the filtering bleb and macular folds. On gonioscopy, the former scleral fistula appeared as a very discrete, narrow closing line. |
Conclusie | This case report demonstrates the possibility of symptomatic hypotony due to the traumatic creation of a scleral fistula, many years after prior ICCE, and the resolution of clinical signs and symptoms after surgical repair of this fistula. |
Belangenverstrengeling | Nee |
Naam | LEMMENS |
Initialen | SL |
Instituut | University Hospitals UZ Leuven/KU Leuven |
Stad | Leuven |
Naam | HUA |
Initialen | MTH |
Instituut | University Hospitals UZ Leuven |
Stad | Leuven |
Naam | STALMANS |
Initialen | IS |
Instituut | University Hospitals UZ Leuven/KU Leuven |
Stad | Leuven |