Surgical management of the symptomatic overhanging filtering bleb

Purpose: Large filtering blebs that evolve after trabeculectomies can be bo thersome to the patient, especially when overhanging the cornea. Partial bl eb excision is warranted to relieve the patient from discomfort or even vis ual impairment. Methods: Surgical partial excision of the overhanging corneal part of the b leb was performed in four patients who had undergone earlier trabeculectomy without application of antimetabolites. Duration of follow-up after excisi on ranged from 9 months to 4 years. Results: Successful reduction of the excessive bleb and continued satisfact ory control of intraocular pressure (IOP) were achieved in all four cases. Partial excision of the corneal part of the bleb did not lead to bleb leaka ge in any of the cases. Conclusion: Surgical blunt dissection of the overhanging part of the exuber ant bleb seems to be a potential method of successfully rearranging the mor phologic features of the bleb and ensuring continued control of IOP and rel ief of symptoms. Alternative methods, such as autologous blood injection, c ryoapplication, application of trichloracetic acid, or application of Nd:YA G laser, are noninvasive but do not allow precise rearrangement of bleb arc hitecture.