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Case report
Blebophthalmos: proptosis due to a massive bleb following implant surgery in refractory paediatric glaucoma
  1. Sriramani Gollakota1,
  2. Pasyanthi Balijepalli2,
  3. Ashutosh Richhariya2 and
  4. Sirisha Senthil2
  1. 1Glaucoma, LV Prasad Eye Institute, Vijayawada, India
  2. 2VST Center for Glaucoma Care, LV Prasad Eye Institute, Hyderabad, India
  1. Correspondence to Dr Sirisha Senthil; sirishasenthil{at}lvpei.org

Abstract

A 5-year-old boy with failed combined trabeculotomy and trabeculectomy underwent Ahmed glaucoma valve (AGV) implantation and presented 5 weeks postoperatively, with sudden onset proptosis downward displacement of the globe, limited extraocular movements and displacement of tube from anterior chamber. CT scan of the orbits showed a large cystic bleb with posterior dislocation of the implant and was explanted. In vitro testing of implant for fluid flow characteristics revealed a dysfunctional valve with anterior leak, which could have possibly lead to anterior and inferior fluid accumulation resulting in displacement of implant, a probable cause for this rare complication. The case was successfully managed later with the Aurolab aqueous drainage device implantation. This case report cautions the surgeon for the possibility of a large cystic bleb following abnormal leak in AGV resulting in orbital complications like proptosis, motility limitation and impending optic nerve compression.

  • glaucoma
  • anterior chamber
  • paediatrics

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Footnotes

  • Contributors SS managed the case. SG and PB drafted the manuscript and designed the images. Revision was done by SS and SG. AGV valve experiment conducted by AR.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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