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Title

Patient creates filtering bleb: hypotony following traumatic rupture of an old scleral tunnel for cataract surgery

Purpose	To describe a case where a patient involuntarily creates a filtering bleb, many years after cataract surgery.
Methods	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.
Results	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.
Conclusion	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.
Conflict of interest	No

Authors 1

Last name	LEMMENS
Initials	SL
Department	University Hospitals UZ Leuven/KU Leuven
City	Leuven

Authors 2

Last name	HUA
Initials	MTH
Department	University Hospitals UZ Leuven
City	Leuven

Authors 3

Last name	STALMANS
Initials	IS
Department	University Hospitals UZ Leuven/KU Leuven
City	Leuven