J Korean Ophthalmol Soc.  2012 Sep;53(9):1364-1367. 10.3341/jkos.2012.53.9.1364.

Surgical Treatment of Overhanging Bleb Using Indocyanin Green Dye

• Jung JJ
• Lee JJ
• Kim HK
• Sohn YH

• KMID: 2216094
• DOI: http://doi.org/10.3341/jkos.2012.53.9.1364

Abstract

PURPOSE
To report a case of overhanging bleb excision using Indocyanin green (ICG) dye.
CASE SUMMARY
A 71-year-old man visited our clinic complaining of a white corneal foreign body in his left eye. The patient underwent mitomycin-assisted trabeculectomy surgery 8 years prior. Slit lamp examination revealed a large overhanging bleb. Because of its large size, surgical excision using ICG dye was performed. After excision surgery, the IOP was well controlled and no anterior chamber inflammation was observed. Two months later, the IOP was still stable at 11 mm Hg and no recurrence of the overhanging bleb was found.
CONCLUSIONS
ICG dye is useful in delineating between a functioning bleb and a non-functioning overhanging bleb. ICG dye-assisted bleb excision is a useful method for decreasing complications such as aqueous humor leakage and damage of the original bleb.

Keyword

Indocyanin green dye; Overhanging bleb; Trabeculectomy

MeSH Terms

Aged
Anterior Chamber
Aqueous Humor
Blister
Eye
Foreign Bodies
Humans
Inflammation
Recurrence
Trabeculectomy

Figure

• 

  Figure 1 (A) Anterior segment photography of preoperative overhanging bleb. (B) The bleb covers 1/3 of the upper nasal side cornea.

• 

  Figure 2 (A) The postoperative 2 month anterior segment slit lamp photography. (B) The overhanging bleb was completely removed. (C) Remaining functioning bleb is still multicystic and well elevated.

• 

  Figure 3 (A) Preoperative overhanging bleb. (B) ICG dye injection into the functioning bleb for separation from the non-functioning bleb. (C) Delineation of the bleb margin from the cornea using Vannas scissor. (D) Peeling of remaining non-functioning overhanging bleb by spatula. (E) Removal of the overhanging bleb. (F) No leakage found.

Reference

1. Ashaye AO, Komolafe OO. Post-operative complication of trabeculectomy in Ibadan, Nigeria: outcome of 1-year follow-up. Eye (Lond). 2009. 23:448–452.

2. Bell RW, Habib NE, O'Brien C. Long-term results and complications after trabeculectomy with a single per-operative application of 5-fluorouracil. Eye (Lond). 1997. 11(Pt 5):663–671.

3. Anis S, Ritch R, Shihadeh W, Liebmann J. Sutureless revision of overhanging filtering blebs. Arch Ophthalmol. 2006. 124:1317–1320.

4. Sony P, Kumar H, Pushker N. Treatment of overhanging blebs with frequency-doubled Nd:YAG laser. Ophthalmic Surg Lasers Imaging. 2004. 35:429–432.

5. Desai K, Krishna R. Surgical management of a dysfunctional filtering bleb. Ophthalmic Surg Lasers. 2002. 33:501–503.

6. Kim S, Kee C. A case of human amniotic membrane transplantation for the treatment of overhanging bleb. J Korean Ophthalmol Soc. 2000. 41:1801–1806.

7. Horiguchi M, Miyake K, Ohta I, Ito Y. Staining of the lens capsule for circular continuous capsulorrhexis in eyes with white cataract. Arch Ophthalmol. 1998. 116:535–537.

8. Kobayashi A, Saeki A, Nishimura A, et al. Visualization of conjunctival cyst by indocyanine green. Am J Ophthalmol. 2002. 133:827–828.

9. Ito K, Miura K, Sugimoto K, et al. Use of indocyanine green during excision of an overhanging filtering bleb. Jpn J Ophthalmol. 2007. 51:57–59.

10. Kim WK, Seong GJ, Lee CS, et al. Anterior segment optical coherence tomography imaging and histopathologic findings of an overhanging filtering bleb. Eye (Lond). 2008. 22:1520–1521.

11. Prata TS, De Moraes CG, Palmiero PM, et al. Slit-lamp-adapted optical coherence tomography for assessment of an overhanging filtering bleb. Acta Ophthalmol. 2010. 88:910–911.