Bleb window cryopexy for the management of oversized, misplaced blebs

Purpose: To describe a new technique for revising oversized blebs after tra beculectomy. Methods: A chart review of consecutive patients undergoing bleb window cryo pexy was conducted. Patients with symptomatic oversized blebs were candidat es for the technique, regardless of the intraocular pressure. Under topical anesthesia, the bleb was incised and a 3 mm x 3 mm conjunctival window was removed using 0.12 forceps and Vannas scissors. Light cryotherapy was appl ied to the sclera through the window. A soft bandage contact lens was then placed for compression, and a patch was applied. All patients were given an tibiotic drops the first day after surgery. Topical corticosteroid drops we re used to minimize postoperative inflammation. Outcome measures included r elief of symptoms, adequate control of intraocular pressure, and restoratio n of filtering bleb function without further antiglaucoma medication or sur gical bleb revision. Results: Nine patients met the inclusion criteria. All patients had flatten ing of the bleb with symptomatic relief within 2 weeks. No loss of bleb fun ction occurred. One patient developed aqueous misdirection after the proced ure. Conclusion: Early results showed that bleb window cryopexy is safe and effe ctive. This minimally invasive technique can be useful for selected patient s with large, symptomatic, overhanging blebs.